Agence France Presse (AFP) News
Nov. 11, 2009

WASHINGTON — The number of US veterans who died in 2008 because they lacked health insurance was 14 times higher than the US military death toll in Afghanistan that year, according to a new study.

The analysis produced by two Harvard medical researchers estimates that 2,266 US military veterans under the age of 65 died in 2008 because they lacked health coverage and had reduced access to medical care.

That figure is more than 14 times higher than the 155 US troop deaths in Afghanistan in 2008, the study says.

Released as the United States commemorates fallen soldiers on Veterans Day, the study warns that even health care provided by the Veterans Health Administration (VA) leaves many veterans without coverage.

The analysis uses census data to isolate the number of US veterans who lack both private health coverage and care offered by the VA.

“That’s a group that’s about 1.5 million people,” said David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program who co-authored the study.

Himmelstein and co-author Stephanie Woolhandler, also a Harvard medical professor, overlaid that figure with another study examining the mortality rate associated with lack of health insurance.

“The uninsured have about a 40 percent higher risk of dying each year than otherwise comparable insured individuals,” Himmelstein told AFP.

“Putting that all together you get an estimate of almost 2,300 — 2,266 veterans who die each year from lack of health insurance.”

Only some US veterans have access to medical care through the VA and coverage is apportioned on the basis of eight “priority groups.”

“They range from things like people who were prisoners of war, who have coverage for life, or who have battle injuries and therefore have coverage for their injuries for life,” said Himmelstein.

Veterans who fall below an income threshold that is determined on a county-by-county basis can qualify for care, but many veterans are “working poor” and fall just above the bracket.

“The priority eight group, the lowest priority, are veterans above the very poor group who have no other reason to be eligible and that group is essentially shut out of the VA,” according to Himmelstein.

The study comes as the US Senate weighs health care reform legislation and whether to offer government health insurance.

Himmelstein warns that congressional proposals could still leave veterans uncovered and favors a national health care program similar to those in Britain and Canada.

http://www.google.com/hostednews/afp/article/ALeqM5iXSJa5eFMuXF2Uxwptns_JOxRcMA

By Jonathan Cohn
Senior Editor
The New Republic
November 10, 2009

Critics have complained that a drug industry got a sweetheart deal when it struck a bargain with the White House and Senate Finance Committee over health care reform.

There’s new reason to think those critics were right.

It comes from an October forecast by IMS Health, a respected global research and consulting firm. The report, which IMS distributed to clients and which a source provided, projects that the drug industry will see average annual growth of 3.5 percent between 2008 and 2013.

Back in March, IMS had projected no growth at all during that same five-year stretch. In fact, it projected the drug business would actually contract slightly–with negative annual growth of 0.01 percent.

What changed? A major factor, according to IMS, was the emerging details of health care reform.

Health reform, as currently envisioned, wouldn’t merely bring coverage to the uninsured. It would also fill in the “donut hole” in Medicare Part D–the gap in coverage that leaves beneficiaries with serious health problems paying for hundred if not thousands of dollars in out-of-pocket prescription costs.

In addition, because it will take several years to close the donut hole, reform relies on voluntary discounts from the pharmaceutical industry to make drugs more affordable in the intervening years. But those discounts would apply only to name-brand drugs, not generics.

Put it all together, and you have more demand for name-brand drugs. As a result, IMS believes, pharmaceutical companies would be able to raise their prices–enough to boost revenue significantly: “If this bill is implemented,” the report concludes on page 138, “an increase in prices on new drugs can be expected.”

Exactly what this would mean in actual dollar terms isn’t clear. But from some back-of-the-envelope calculations, it appears that IMS thinks revenues for the makers of name-brand drugs could grow by hundreds of billions of dollars over the next ten years. (To be clear, this is a very rough guess, based on extrapolations from the report’s tables–and I have not run it by experts.)

That brings us back to the deal that the Pharmaceutical Researchers and Manufacturers of America, which represents those companies, made with the White House and Senate Finance Committee.

The deal–details of which came to light in reports by the New York Times and Huffington Post–was pretty straightforward. The industry agreed to embrace health care reform and, later on, launched a massive advertising campaign to promote the cause. In exchange, the White House and Senate Finance–which had been asking various industries to pledge concessions that would help pay for the cost of coverage expansions–promised not to seek more than $80 in reduced payments to drug makers.

To an industry as big and profitable as the drug makers, giving up $80 billion over ten years wouldn’t seem like much of a sacrifice–a point critics started making right away. But if IMS is right, the drug industry wouldn’t even be giving up $80 billion, in any meaningful sense of the term. If anything, it’d be making more money. Maybe quite a lot of it.

Of course, the projections from IMS–like any such projections–are full of uncertainty. That’s why there are so many “coulds” and “mights’ in the explanation above.

And even if the drug industry is getting a sweetheart deal, the political reality remains what it was all along. As I noted in my recent article on the drug deal, the drug industry has enormous leverage in Congress: When relatively liberal congressional committees tried limit the exclusivity period for biological drugs, industry lobbyists beat back the effort easily.

Given the tight squeeze in Congress–remember, even the House passed reform with only a tiny, five-vote margin–it’s entirely possible that declaring war on the drug lobby would have undermined the whole reform effort.

Then again, the House version of reform does seek greater concessions from the drug industry than the Senate Finance bill does. And the two chambers’ bills must eventually be reconciled in conference committee.

The drug industry will complain about any efforts to alter their deal. But the IMS projection suggests they’ll be just fine.

Note: Calls and emails to IMS were not returned.

By Elyse Siegel
The Huffington Post
Nov. 11, 2009

According to a study released by the Harvard Medical School, 2,266 veterans under the age of 65 died last year as a result of not having health insurance. Researchers emphasize that “that figure is more than 14 times the number of deaths (155) suffered by U.S. troops in Afghanistan in 2008, and more than twice as many as have died (911 as of Oct. 31) since the war began in 2001.”

The 1.46 million working-age veterans that did not have health insurance last year all experienced reduced access to care as a consequence, leading to “six preventable deaths a day.”

Like other uninsured Americans, most uninsured vets are working people — too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,” said Dr. Steffie Woolhandler, a professor at Harvard Medical School. […]

Dr. David Himmelstein, the co-author of the report and associate professor of medicine at Harvard, commented, “On this Veterans Day we should not only honor the nearly 500 soldiers who have died this year in Iraq and Afghanistan, but also the more than 2,200 veterans who were killed by our broken health insurance system. That’s six preventable deaths a day.”

http://www.huffingtonpost.com/2009/11/10/2266-veterans-died-in-200_n_353033.html

By Viji Sundaram
New America Media
Nov 10, 2009

Michael Baranik Jennings called it the worst day of his life.

As he sat in his doctor’s office that day in January 2007, he was told he had terminal cancer.

As if that wasn’t bad enough, he was also told that his veteran’s health care insurance wasn’t adequate to cover the number of chemotherapy sessions he would need.

Over the next few weeks, Jennings went from one doctor to another, hoping to find one who would give him the needed treatment.

“Luckily, I begged and begged a doctor, who said he would only give me seven treatments because of insurance,” Jennings wrote in a letter to the non-profit, National Nurses Organizing Committee.

But his efforts weren’t enough. Jennings died a few months after he was diagnosed with terminal cancer.

Jennings story is not unique. Lack of health insurance claimed the lives of more than 2,266 veterans under the age of 65 last year, says a Harvard Medical School study out today.

That number is more than 14 times the number of deaths (155) suffered by U.S. troops in Afghanistan in 2008, and twice as many (911 as of Oct. 31) as have died since the war began in 2003.

“Uninsured veterans are a stain on America’s flag,” asserted Dr. Steffie Woolhandler, one of the study’s three researchers and professor of medicine at the school. “It’s particularly striking that a combat veteran who has already served his country is denied [adequate] health care.”

The Harvard researchers said that health care reform legislation pending in the House and Senate would not “significantly affect this grim picture.”

Only a minority of veterans — those disabled by military service — is automatically eligible for VA care.

Vets who have a combat-related injury and are 100 percent disabled can get full care from the VA, said Allan Campbell, a veteran of the Vietnam war. Campbell said he had to “fight for years and years before he could go from 10 percent care to 100 percent care.”

The full-care veterans who live far from a VA hospital or clinic also get reimbursed for travel.

“I am a U.S. Navy vet,” wrote a 52-year-old vet from Novato, Calif., to the National Nurses Organizing Committee. “With the VA almost 50 miles from my front door, it just doesn’t work for me in case of an emergency-type situation.”

Woolhandler said researchers analyzed data from the U.S. Census Bureau’s March 2009 Current Population Survey, which queried Americans about their insurance coverage and veteran status.

The survey found that 1,461,615 veterans between the ages of 18 and 64 were uninsured — that is, they neither had health insurance nor received ongoing care at Veterans Health Administration hospitals or clinics — in 2008.

Their research found that being uninsured raises an individual’s odds of dying by 40 percent, causing 44,798 deaths in the United States annually among those aged 17 to 64. With that data, Woolhandler and her colleagues arrived at their estimate of 2,266 preventable deaths of non-elderly veterans in 2008.

“Like other uninsured Americans, most uninsured vets are working people — too poor to afford private coverage, but not poor enough to qualify for Medicaid or means-tested VA care,” said Woolhandler, who testified before the House Committee on Veterans Affairs in 2007 about uninsured veterans.

The Veterans Eligibility Reform Act opened VA enrollment to all veterans, although non-poor veterans (generally, those earning more than $30,000 a year) were required to make co-payments of up to $50 per day for outpatient care.

However, in 2002, the Bush administration ordered VA regional directors to “stop marketing to enroll Priority 8 veterans,” citing lack of financial resources. Enrollment stopped on Jan. 17, 2003. Veterans without service-connected illnesses or disabilities, and with incomes above 80 percent of the median income in their area are classified in the lowest priority group, Priority 8.

Bowing to pressure from veterans’ advocates, the Obama administration earlier this year adjusted the income-standards means test. That allowed around 10 percent of uninsured vets to enroll. “But that still left 1.5 million of them uninsured,” Woolhandler noted.

Dr. David Himmelstein, co-author of the Harvard study and associate professor of medicine at the school, noted that the “unnecessary deaths will continue under the legislation now before the House and Senate.

“Those bills would do virtually nothing for the uninsured until 2013, and leave at least 17 million uninsured over the long run. We need a solution that works for all veterans — and for all Americans — single-payer national health insurance.”

Woolhandler said that allowing stories such as Jennings’ to happen, is “a national disgrace,” and “a total negation of the service they have given us.”

Liz Jacobs, of the California Nurses Association, said Jennings was “very ill” when he contacted them two years ago. In the letter he wrote to the National Nurses Organizing Committee he said, “This is what I get for serving my country for 24 years…If I had known this when I joined, I would never have joined.

“I would have left this country, given up my citizenship and lived in a country where they respect the men and women that protect their freedom.”

http://news.newamericamedia.org/news/view_article.html?article_id=bce61abde2d70c73fb6ea5db2c4b8403

Of all the torrent of words that followed House passage of its version of healthcare reform legislation in early November, perhaps the most misleading were those comparing it to enactment of Social Security and Medicare.

Sadly no. Social Security and Medicare were both federal programs guaranteeing respectively pensions and health care for our nation’s seniors, paid for and administered by the federal government with public oversight and public accountability.

While the House bill, and its Senate counterpart, do have several important reform components, along with many weaknesses, neither one comes close to the guarantees and the expansion of health and income security provided by Social Security or Medicare.

By contrast, if the central premise of Social Security and Medicare was a federal guarantee of health and retirement security, the main provision of the bills in Congress is a mandate requiring most Americans without health coverage to buy private insurance.

In other words, the principle beneficiary is not Americans’ health, but the bottom line of the insurance industry which stands to harvest tens of billions of dollars in additional profits ordered by the federal government. Or as Rep. Eric Massa of New York put it on the eve of the House vote, “at the highest level, this bill will enshrine in law the monopolistic powers of the private health insurance industry, period.”

Further, while Social Security and Medicare, two of the most important reforms in American history, were both significant expansions of public protection, the House bill actually reduces public protection for a substantial segment of the population, women, with its unconscionable rollback of reproductive rights in the anti-abortion amendment.

Why then so much cheerleading by many progressive and liberal legislators, columnists, and activists?

1- Passage of the bill was a clear defeat for the Republican opposition and those on the right who have so mischaracterized what boils down to modest reform that looks more like a “robust” version of the Medicare prescription drug benefit or the state children’s health initiative.

2- Proponents of the bill, starting in the White House and running through the Democratic leadership in Congress, with the assistance and support of many in labor and liberal and progressive constituency groups, have so lowered expectations on healthcare reform that with eyes wide shut they can call this a sweeping victory.

To be sure there are commendable provisions in the House bill that bear note. Among the most important are:

* Expansion of Medicaid to millions of low income adults.

* Reduction of the “doughnut hole” in the Medicare drug coverage law making drug costs more affordable for many seniors.

* Increased federal funding for community health programs, such as home visits for nurses and social workers to low income families.

* Additional regulation of the insurance industry, mostly targeted to people who are presently without coverage rather than those with existing health plans. Those include limits on insurers ability to drop sick enrollees or refuse to sell policies to people with prior health problems, extending the age that dependent children can be on their parents’ plan, and repeal of the anti-trust exemption for insurers.

* Extending the same health benefit tax benefits available to married couples to domestic partners.

* A progressive tax to help pay the bill through a surcharge on wealthy earners and required contributions from large employers, in sharp contrast with the Senate proposal to tax health benefits on misnamed “Cadillac” plans, comprehensive coverage available to many union members, for example.

But the acclaim now flowing from some quarters would have been better deserved had these provisions been enacted on their own — not accompanied by the many shortcomings of the legislation. To cite a few:

* Healthcare will remain unaffordable for many Americans. The bill does not do nearly enough to control skyrocketing insurance, pharmaceutical, and hospital costs. Indeed, by various estimates, with no effective limits on the insurance industry’s price gouging, out-of-pocket costs for premiums, deductibles and other fees by some estimates with eat up from 15 to 19 percent of family incomes by several accounts.

* No meaningful reform of the rampant insurance denials of medical treatment the insurers don’t want to pay for.

* Little assistance for individuals and families who presently have employer-sponsored health plans and face frequent erosion of their coverage and health security. No help for the healthcare cost-shifting from employers to employees.

* Minimal expansion of consumer choice. The much debated public plan option will be available only to about 2 percent of people under age 65, mostly those now not covered who buy insurance on their own (it may or may not be expanded in 2015). Further, no additional plan options for those in the many markets dominated by one or two private plans, and no additional choice of doctor or hospital within existing plans.

* The new limits on abortion extended to poor women.

Ultimately, the combination of the mandate to buy insurance, federal subsidies to low income families to purchase private plans, failure to adequately control insurance prices or crack down on the abuse of insurance denials make the House bill — and its Senate counterpart — look a lot like a massive bailout for the private insurance industry.

Don’t be misled by the howling from insurance industry which has been spending some $1.4 million a day to steer the direction of legislation. They would have preferred the status quo, but will be more than happy to count the increased revenues coming their way.

As Rep. Dennis Kucinich said on the House floor, “we cannot fault the insurance companies for being what they are. But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem.”

While some people will have improved access, the final accounting will be an even firmer private insurance grip on our healthcare system, with the U.S. remaining the only industrialized nation which barters our health for private profit.

Months ago, the Obama administration pre-determined this outcome by ruling out the most comprehensive, most cost effective, most humane reform, single payer, or an expanded and improved Medicare for all. Single payer proponents were shut out of White House forums, blocked from most hearings in the Senate, and single payer amendments stripped from the final House bill. Yet, through grassroots pressure, single-payer advocates forced consideration by the House of an improved Medicare for all until the very end.

But nurses and other single payer proponents who have heroically fought for this reform for years will continue the campaign, next in the Senate, where single payer amendments are expected to be introduced. The scene will also shift to state capitols, where vibrant single payer movements remain active and will escalate.

Proponents of comprehensive reform will never be silent, and never stop working for the real change we most desperately need.

By Marcia Angell, M.D.
Physician, Author, Senior Lecturer, Harvard Medical School
The Huffington Post
November 8, 2009

Well, the House health reform bill — known to Republicans as the Government Takeover — finally passed after one of Congress’s longer, less enlightening debates. Two stalwarts of the single-payer movement split their votes; John Conyers voted for it; Dennis Kucinich against. Kucinich was right.

Conservative rhetoric notwithstanding, the House bill is not a “government takeover.” I wish it were. Instead, it enshrines and subsidizes the “takeover” by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn’t regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.

What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers — those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65’s will be more likely to go without insurance, even if they have to pay fines. That’s OK with the industry, since these would be among their sickest customers. (Shouldn’t age be considered a pre-existing condition?)

Insurers also won’t have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an “option” at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it’s been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.

If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?

First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers — government and employers — will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.

But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It’s a shell game in which money is moved from one part of our fragmented system to another.

Here is my program for real reform:

Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it’s a better program, because it ensures that everyone has access to a uniform package of benefits.

Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.

Recommendation #3: Medicare should monitor doctors’ practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.

Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.

Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.

Is the House bill better than nothing? I don’t think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

Read more at: http://www.huffingtonpost.com/marcia-angell-md/is-the-house-health-care_b_350190.html&cp