PNHP

45,000 American deaths associated with lack of insurance

45,000 American deaths associated with lack of insurance

By Madison Park
CNNhealth.com
Sept. 18, 2009

A freelance cameraman’s appendix ruptured and by the time he was admitted to surgery, it was too late. A self-employed mother of two is found dead in bed from undiagnosed heart disease. A 26-year-old aspiring fashion designer collapsed in her bathroom after feeling unusually fatigued for days.

Paul Hannum’s family members say he probably would’ve gone to the hospital earlier if he had had health insurance.

What all three of these people have in common is that they experienced symptoms, but didn’t seek care because they were uninsured and they worried about the hospital expense, according to their families. All three died.

Research released this week in the American Journal of Public Health estimates that 45,000 deaths per year in the United States are associated with the lack of health insurance. If a person is uninsured, “it means you’re at mortal risk,” said one of the authors, Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School.

The researchers examined government health surveys from more than 9,000 people aged 17 to 64, taken from 1986-1994, and then followed up through 2000. They determined that the uninsured have a 40 percent higher risk of death than those with private health insurance as a result of being unable to obtain necessary medical care. The researchers then extrapolated the results to census data from 2005 and calculated there were 44,789 deaths associated with lack of health insurance.

For years, Paul Hannum didn’t have health insurance while he worked as a freelance cameraman in southern California.

One Sunday, Hannum complained of a stomachache which alarmed his pregnant fiancée, Sarah Percy. “He wasn’t a complainer,” she said. “He’s the type of guy who, if he got a cold, he’ll power through it. I never had known him to complain about anything.”

Hannum thought he had a stomach flu or food poisoning from bad chicken. On Monday, his brother saw him looking ashen and urged him to go to the hospital. “He had a little girl on the way,” his older brother Curtis Hannum said. “He didn’t want the added burden of an ER visit to hang on their finances. He thought ‘I’ll just wait,’ and he got worse and worse.”

By the time Hannum got to the hospital and was admitted to surgery, it was too late.

Paul Hannum, 45, died on Thursday, August 3, 2006, from a ruptured appendix. His daughter, Cameron was born two months later.

Other studies have indicated that the uninsured are at greater risk of mortality than the insured. A 2007 study from The American Cancer Society found that uninsured cancer patients are 1.6 times more likely to die within five years of their diagnosis than those with private insurance. In 2002, the Institute of Medicine estimated that lack of health insurance caused about 18,000 deaths every year.

The latest findings come amid the fierce debate over health care reform in the U.S.

Two authors of the Harvard study, Himmelstein and Dr. Steffie Woolhandler are co-founders of the Physicians for a National Health Program, which supports government-backed “single-payer” health coverage.

The National Center for Policy Analysis, which backs “free-market” health care reform, calls the Harvard research flawed.

“The findings in this research are based on faulty methodology and the death risk is significantly overstated,” said John C. Goodman, the president of the NCPA in a statement. But Goodman did note there is “a genuine crisis of the uninsured in this country.”

The lead author of the Harvard study, Dr. Andrew Wilper said he’s confident in his and his colleagues’ estimates. “It’s consistent with the vast body of literature that has found reasonably similar findings,” said Wilper, instructor in internal medicine at the University of Washington. “There’s broad agreement in the health literature regarding this point.”

Wilper said there is often fear from those, including his own grandmother, who don’t feel well but avoid the hospital because it could mean financial catastrophe.

For 10 years, Sue Riek suffered from back pain, but couldn’t afford medical care.

When a mid-life divorce left her single and without health insurance, Riek started a home-business selling make-up on eBay to support herself and her two daughters.

Riek, who lived in Charlotte, North Carolina, didn’t qualify for Medicaid. And she couldn’t afford a $5,000 monthly insurance premium, said her eldest daughter, Kaytee Riek.

“I don’t know if she felt trapped, but it was a constant in her life — struggling outside the health care system to exist,” her daughter said.

Riek took comfort in her faith and regularly attended church. Then one Sunday, she didn’t show up.

The next day, September 3, 2007, her daughter received the call telling her that her 51-year-old mother died from undiagnosed heart disease — a condition treatable with lifestyle changes, medication and certain medical procedures.

“I feel incredibly strongly that she would still be alive if she had been able to regularly see a doctor,” said her daughter.

It has become lethal to be uninsured, said Woolhandler, an associate professor of medicine at Harvard.

“If you can get good primary care for your high blood pressure, your high cholesterol, diabetes — those don’t have to be lethal conditions,” she said. “If you fail to get good ongoing primary care, you may end up with complications and even death.”

The ranks of the uninsured have grown, according to the U.S. Census Bureau. It says the number of Americans without health insurance rose to 46.3 million last year, up from 45.7 million in 2007. The percentage of the uninsured remained at 15.4 percent.

Young adults are more likely to be uninsured. Elizabeth Machol, 25, told her mother she felt tired. She had just moved into a new apartment in Santa Rosa, California, with her boyfriend and thought the fatigue was from the move and her cat Bert, who would keep her up at night.

Her mother, Marlena Machol told her to go to the doctor’s office, but Machol was reluctant. Machol worked at a movie theater and didn’t have health insurance. Her parents were still paying her medical bills from a previous condition and she was worried about the cost.

A few days after their phone conversation, Machol collapsed in the bathroom. She never regained consciousness.

One day after her 26th birthday, Machol was declared brain dead.

After signing papers to donate her organs, her parents kissed her face, held her hands and said goodbye to the daughter who had played the violin, organized her own fashion show and taught neighborhood kids how to swim. The coroner’s office could not determine the cause of death.

Six years after her death on September 22, 2003, her family wonders if things would’ve been different had she not feared the cost of going to the hospital.

“Maybe they would’ve found out what’s wrong,” her mother said. “I don’t know if that would’ve saved her, but it would’ve been a chance to. There are people like Elizabeth — young people who are starting out in life and they don’t have options.”

http://www.cnn.com/2009/HEALTH/09/18/deaths.health.insurance/

Where are the price controls?

Mandate minus price controls may increase healthcare costs

By Noam N. Levey and James Oliphant
Los Angeles Times
September 24, 2009

In the drive to bring health coverage to almost every American, lawmakers have largely rejected restrictions on how much insurers can charge, sparking fears that consumers will continue to face the skyrocketing premium increases of recent years.

The legislators’ reluctance to control premium costs comes despite the fact that they intend to require virtually all Americans to get health insurance, an unprecedented mandate — long sought by insurance companies — that would mark the first time the federal government has compelled consumers to buy a single industry’s product, effectively creating a captive market.

“We are about to force at least 30 million people into an insurance market where the sharks are circling,” said California Lt. Gov. John Garamendi, a Democrat who served as the state’s insurance commissioner for eight years. “Without effective protections, they will be eaten alive.”

But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector.

As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.

“That would be a very substantial additional intervention in the marketplace,” said Sen. Jeff Bingaman (D-N.M.), a member of a bipartisan group of lawmakers who worked with Senate Finance Committee Chairman Max Baucus (D-Mont.) on his healthcare bill. “I just don’t think the support would be there for that kind of a change.”

Nor are lawmakers seriously considering any proposals to regulate what doctors, hospitals, drug makers and other healthcare providers charge — a strategy used by several European countries to control healthcare spending.

But even the insurance industry’s leading representative in Washington acknowledged that those reforms may not slow the rising cost of premiums soon.

“You can’t restrain premiums unless you restrain medical costs,” said Karen Ignagni, president of America’s Health Insurance Plans, on the industry’s view of the problem. “So far, members of Congress have been allergic to that.”

http://www.latimes.com/news/nationworld/nation/la-na-healthcare-affordability2-2009sep24,0,2139648,full.story

“It’s the Prices,Stupid:”
https://pnhp.org/system/assets/drupal/single_payer_resources/prices_stupid.pdf

Comment:

By Don McCanne, MD

One of the more unique features of the health care system in the United States is that we spend far more on care even though our use of health care services is comparable to other nations. The difference is in the prices. Other nations use government regulation to improve pricing, but the United States persists in refusing to intervene in market pricing.

Does the current model of reform under consideration by Congress do anything to alleviate the upward pressure on prices? They propose an exchange of competing private plans to control prices, while explicitly excluding a public plan with “administered pricing.” So the answer is “no.” Market competition of private plans has had no impact on controlling health care spending in the past, and there is no private sector mechanism that would have any beneficial impact in the future.

Think of the regulatory changes proposed. Congress would require insurers to accept those who they currently exclude because of preexisting disorders. They would place a limit on out-of-pocket expenses, requiring the balance to be paid by the insurers. They would remove the lifetime cap on coverage, requiring insurers to pick up the costs of those with very expensive medical problems. These and other measures would result in significant increases in private health insurance premiums, making the plans even less affordable.

Since insurers would be required to compete with each other, they would have to continue to pay our comparatively high prices if they are to attract enough physicians and hospitals to guarantee adequate provider networks. That’s the way the market works. Thus the current model of reform is a guarantee that we will continue to see unaffordable pricing throughout our health care system.

In a remarkable moment of candor, the insurance industry’s chief lobbyist, AHIP’s Karen Ignagni, states that Congress has been “allergic” to restraining medical costs. Since the private insurance industry has been in charge for the past several decades, obviously they are hopelessly allergic as well – incurably so.

Do we want to be a captive market of the private insurance industry? Or do we want to be captives of a public insurance program like Medicare? Just ask our seniors what they thought on turning 65.

Key Features of Single-Payer

  • Universal, Comprehensive Coverage
    Only such coverage ensures access, avoids a two-class system, and minimizes expense
  • No out-of-pocket payments
    Co-payments and deductibles are barriers to access, administratively unwieldy, and unnecessary for cost containment
  • A single insurance plan in each region, administered by a public or quasi-public agency
    A fragmentary payment system that entrusts private firms with administration ensures the waste of billions of dollars on useless paper pushing and profits. Private insurance duplicating public coverage fosters two-class care and drives up costs; such duplication should be prohibited
  • Global operating budgets for hospitals, nursing homes, allowed group and staff model HMOs and other providers with separate allocation of capital funds
    Billing on a per-patient basis creates unnecessary administrative complexity and expense. A budget separate from operating expenses will be allowed for capital improvements
  • Free Choice of Providers
    Patients should be free to seek care from any licensed health care provider, without financial incentives or penalties
  • Public Accountability, Not Corporate Dictates
    The public has an absolute right to democratically set overall health policies and priorities, but medical decisions must be made by patients and providers rather than dictated from afar. Market mechanisms principally empower employers and insurance bureaucrats pursuing narrow financial interests
  • Ban on For-Profit Health Care Providers
    Profit seeking inevitably distorts care and diverts resources from patients to investors
  • Protection of the rights of health care and insurance workers
    A single-payer national health program would eliminate the jobs of hundreds of thousands of people who currently perform billing, advertising, eligibility determination, and other superfluous tasks. These workers must be guaranteed retraining and placement in meaningful jobs.

from the American Journal of Public Health January 2003, Vol 93, No.1

Insurance and Equity in Primary Care and Specialist Office Visits

Universal Health Insurance and Equity in Primary Care and Specialist Office Visits: A Population-Based Study

By Richard H. Glazier, MD, MPH, Mohammad M. Agha, PhD, Rahim Moineddin, PhD and Lyn M. Sibley, PhD
Annals of Family Medicine
September/October 2009
Universal coverage of physician services should serve to reduce socioeconomic disparities in care, but the degree to which a reduction occurs is unclear. We examined equity in use of physician services in Ontario, Canada, after controlling for health status using both self-reported and diagnosis-based measures.
CONCLUSIONS After adjusting for health status, we found equity in contact with primary care for educational attainment but inequity in specialist contact, frequent visits, and bypassing primary care. In this setting, universal health insurance appears to be successful in achieving income equity in physician visits. This strategy alone does not eliminate education-related gradients in specialist care.
http://www.annfammed.org/cgi/content/full/7/5/396

Much of the discussion on health care reform centers around financing reform, with goals of achieving universality and affordability. Effective reform that would actually accomplish that (i.e., single payer) would be a crucial first step toward the even more important goal of reducing the socioeconomic disparities in care. The record on disparities in the United States is shameful.
This study looks at inequities in a country that has already established an equitable, universal financing system for health care: Canada. Three important conclusions: 1) Physician visits for both primary care and specialists were equitable regardless of the income level of the patient, 2) Physician visits for primary care were equitable regardless of the level of the educational achievement of the patient, and 3) Patients with a higher level of educational achievement had greater contact with specialists, often bypassing primary care.
Think of how Canada must struggle with this policy issue. They must determine whether more educated individuals are obtaining an excessive quantity of specialized services, or if those with less education are being deprived of specialized services they should have. Then they have to decide on policies that would improve access or reduce waste, as appropriate.
Compare that to the policy issues we face in the United States. We have a financing system that creates personal financial hardships, results in physical suffering and sometimes even death, and wastes hundreds of billions of dollars that could be redirected to paying for health care services that people need and are not receiving. Canada has passed that hurdle long ago.
Wouldn’t it be nice if we could also be working on the minutiae of health policy instead of the most fundamental changes that we desperately need? Unfortunately, Congress, in moving forward with tweaking the private insurance industry, has decided to work on the minutiae and ignore the basics. Tweaks can never fix a fundamentally flawed financing structure that must first be replaced before it can be tweaked.

The N.Y. Times' nasty swipe at Medicare for All

Comment by Ray Bellamy, MD

http://prescriptions.blogs.nytimes.com/2009/09/19/medicare-for-all-crazy-socialized-and-unlikely/#comment-28137

Prescriptions Blog
New York Times
September 20, 2009

Katharine Q. Seelye really got it all wrong with her analysis of the finances of Medicare for All. Some of the reasons for Medicare’s financial difficulties come readily to mind:

1. Bad Risk Pool of the elderly (think end of life care), and the disabled (think sick).

2. Financing has not changed since 1985. How can funding for healthcare for the sickest of our population be sustained over 24 years of increasing healthcare costs without raising the Medicare tax?

3. Political interference. Effectiveness recommendations have been blocked by Congress, who have mandated coverage for treatments of dubious benefit such as chiropractic and complementary medicine to please constituents. Providers, one who bilked Medicare and was fined over a million dollars twice, are still providers due to political interference. The savings of Medicare for All would be 380 billion dollars or more a year, according to independent analyses, and this is enough to easily extend comprehensive coverage to ALL of the uninsured and have money left over for reducing the deficit. The inclusion of healthy, lower cost younger folks in the risk pool of all Americans spreads the risk and cost along with massive administrative savings. There are additional huge benefits in better effectiveness data to improve quality, as well as identification of overutilization and better cost control by global budgeting and volume discounts. Congress and America would benefit by a head-to-head comparison by an independent agency such as the CBO or other comparing Single Payer with any other proposal you want to offer. Single Payer would win hands down, as the rest of the developed world has already figured out.

Doctors walk for health care

Group supports single-payer plan

By Sean Rose
Courier Journal
September 22, 2009

A group of Oregon doctors stopped by Louisville and Jeffersonville, Ind., on Tuesday to voice their anger over what they see as a broken health care system.

The group, who call themselves the Mad As Hell Doctors and support a single payer health care plan similar to Medicare, staged a rally in Jeffersonville followed by a candle-lit march across the Clark Memorial Bridge to Louisville to memorialize those who die each year because of a lack of access to health care.

Churchill Downs’ bugler, Steve Buttleman, played taps during a moment of silence during the rally.

The doctors left Portland, Ore., earlier this month on a 27-city tour that will end Sept. 30 in Washington, D.C., where they plan to meet with lawmakers and share stories they’ve gathered along the way.

Dr. Eugene Uphoff, of Portland, said he has been a family physician for 41 years and in that time has “seen practically every way people have been raked across the coals by health plans.”

About 100 local citizens joined in the rally, sharing stories of falling into bankruptcy after being dropped by their insurer or having to travel overseas because treatment was cheaper.

Uphoff said the stories people shared illustrate the reasons to support a single payer plan, the first being a moral responsibility.

“We’re a Christian nation, still, I hope, and this is the right thing to do,” Uphoff said. “We should be taking care of neighbors.”

Another benefit a single payer plan has is it’s the only plan being considered in Congress that shifts the health care system from a profit-driven structure, which could save on cost in the future, Uphoff said.

A single payer plan also would allow citizens to have more control over their health care, Uphoff argued, because if everyone “had skin in the game” politicians would be forced to address problems.

“I have no control over the board of directors for Blue Cross,” he said. “I can’t do anything to those folks. But I know where my senators and congressmen are and I know how to get a hold of them.”

The rally and march came as the health care debate continues to simmer in Congress and less than a month after U.S. Rep. John Yarmuth, D-3rd District, faced a boisterous crowd at a town hall meeting on health care reform at Central High School in Louisville.

Many at the rowdy town hall said they were opposed to health care overhaul because they didn’t want the government involved in health care and the cost to taxpayers would be too great.

Since that time, President Barack Obama has been more receptive to a plan that compromises and includes a place for private insurance companies.

The odds are stacked against a single payer plan coming from this Congressional session, something everyone at the march seemed to acknowledge.

“I believe that the plans are getting watered down too much to do any good even if they do pass,” said Ricky George of south Louisville.

“But hopefully this generates attention,” his wife, Nicole, said of the rally.

Charlie Francis, of the Irish Hill neighborhood in Louisville, joined the rally as a supporter of a single payer system and said he wanted to hear the views of people in the medical profession.

“These people are doctors,” he said. “We have senators telling us what we need; doctors are the ones in the business.”

Still, Francis said he didn’t have much hope for actually seeing a single payer plan emerge.

But Uphoff said eventually the cost of health care and problems with the current system would grow too great to handle.

“I don’t know if it’ll be this week or next month or even this year, but what I do know is that until we get a single payer plan, the costs will continue to rise, people will continue to die,” he said. “It will happen, I guarantee it will happen. It’s just a matter of how many people we want to make suffer and die before we enact it.”

Two local groups, Southeast Hoosiers for a Common Sense Health Plan and Kentuckians for Single Payer Health care, sponsored the event.

Groups who have organized rallies in the Louisville area against the health care plan being considered by Congress, Americans for Prosperity and Our Country Deserves Better PAC, could not immediately be reached for comment on Tuesday night.

Reporter Sean Rose can be reached at (502) 582-4199.

Insurance and Equity in Primary Care and Specialist Office Visits

Universal Health Insurance and Equity in Primary Care and Specialist Office Visits: A Population-Based Study

By Richard H. Glazier, MD, MPH, Mohammad M. Agha, PhD, Rahim Moineddin, PhD and Lyn M. Sibley, PhD
Annals of Family Medicine
September/October 2009

Universal coverage of physician services should serve to reduce socioeconomic disparities in care, but the degree to which a reduction occurs is unclear. We examined equity in use of physician services in Ontario, Canada, after controlling for health status using both self-reported and diagnosis-based measures.

CONCLUSIONS After adjusting for health status, we found equity in contact with primary care for educational attainment but inequity in specialist contact, frequent visits, and bypassing primary care. In this setting, universal health insurance appears to be successful in achieving income equity in physician visits. This strategy alone does not eliminate education-related gradients in specialist care.

http://www.annfammed.org/cgi/content/full/7/5/396

Comment:

By Don McCanne, MD

Much of the discussion on health care reform centers around financing reform, with goals of achieving universality and affordability. Effective reform that would actually accomplish that (i.e., single payer) would be a crucial first step toward the even more important goal of reducing the socioeconomic disparities in care. The record on disparities in the United States is shameful.

This study looks at inequities in a country that has already established an equitable, universal financing system for health care: Canada. Three important conclusions: 1) Physician visits for both primary care and specialists were equitable regardless of the income level of the patient, 2) Physician visits for primary care were equitable regardless of the level of the educational achievement of the patient, and 3) Patients with a higher level of educational achievement had greater contact with specialists, often bypassing primary care.

Think of how Canada must struggle with this policy issue. They must determine whether more educated individuals are obtaining an excessive quantity of specialized services, or if those with less education are being deprived of specialized services they should have. Then they have to decide on policies that would improve access or reduce waste, as appropriate.

Compare that to the policy issues we face in the United States. We have a financing system that creates personal financial hardships, results in physical suffering and sometimes even death, and wastes hundreds of billions of dollars that could be redirected to paying for health care services that people need and are not receiving. Canada has passed that hurdle long ago.

Wouldn’t it be nice if we could also be working on the minutiae of health policy instead of the most fundamental changes that we desperately need? Unfortunately, Congress, in moving forward with tweaking the private insurance industry, has decided to work on the minutiae and ignore the basics. Tweaks can never fix a fundamentally flawed financing structure that must first be replaced before it can be tweaked.

The N.Y. Times’ nasty swipe at Medicare for All

Comment by Ray Bellamy, MD

http://prescriptions.blogs.nytimes.com/2009/09/19/medicare-for-all-crazy-socialized-and-unlikely/#comment-28137

Prescriptions Blog
New York Times
September 20, 2009

Katharine Q. Seelye really got it all wrong with her analysis of the finances of Medicare for All. Some of the reasons for Medicare’s financial difficulties come readily to mind:

1. Bad Risk Pool of the elderly (think end of life care), and the disabled (think sick).

2. Financing has not changed since 1985. How can funding for healthcare for the sickest of our population be sustained over 24 years of increasing healthcare costs without raising the Medicare tax?

3. Political interference. Effectiveness recommendations have been blocked by Congress, who have mandated coverage for treatments of dubious benefit such as chiropractic and complementary medicine to please constituents. Providers, one who bilked Medicare and was fined over a million dollars twice, are still providers due to political interference. The savings of Medicare for All would be 380 billion dollars or more a year, according to independent analyses, and this is enough to easily extend comprehensive coverage to ALL of the uninsured and have money left over for reducing the deficit. The inclusion of healthy, lower cost younger folks in the risk pool of all Americans spreads the risk and cost along with massive administrative savings. There are additional huge benefits in better effectiveness data to improve quality, as well as identification of overutilization and better cost control by global budgeting and volume discounts. Congress and America would benefit by a head-to-head comparison by an independent agency such as the CBO or other comparing Single Payer with any other proposal you want to offer. Single Payer would win hands down, as the rest of the developed world has already figured out.

Lessons from California on the insurance mandate

Insurance Mandates Don’t Work

By Jamie Court
The Washington Post
September 21, 2009
A cornerstone of President Obama’s health-care plan is, as he said in his speech to Congress, “individuals will be required to carry basic insurance, just like most states require you to carry auto insurance.” But the tarnished history of such laws shows that making insurance mandatory, and even making it more affordable, does not compel the uninsured to buy it.
In California, the car capital of America, the injustice of mandatory insurance laws sparked one of the great voter revolts of modern history — and that still didn’t solve the uninsured motorist problem. In 1988, the people of California passed Proposition 103, which required auto insurance companies to seek permission through an elected insurance commissioner for premium increases. It created an intervener system that allows members of the public to challenge unnecessary premium hikes. The law also made auto insurance pricing fairer in various ways, including banning ZIP-code based auto insurance.
The Consumer Federation of American reported in 2008 that Proposition 103 had saved Californians $62 billion on their auto insurance. The market is competitive, prices are down, and the number of uninsured motorists has decreased some from pre-Prop 103 levels. Yet in the most competitive auto insurance market in the nation, the uninsured motorist rate is still 18 percent, among the highest. That’s true even after California took more punitive measures against uninsured motorists. Stiffer fines, the impounding of cars and the loss of legal rights for uninsured motorist have not significantly impacted the uninsured motorist rate.
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/21/AR2009092103250.html

The health care reform proposal before Congress would increase regulatory oversight of the private insurers, mandate individuals to purchase their plans, and penalize those who fail to do so. The experience with auto insurance in California should provide us with at least a hint as to whether that is a rational response to the health care crisis.
True, auto insurance and health insurance are not the same thing, but the mandate to purchase either type of insurance applies to the same individuals. Why should we expect a change in behavior merely because the unaffordable insurance product is designed to protect the individual’s health? Even with the proposed subsidies, a very large number of individuals will not have enough funds to pay the premiums and will remain uninsured.
California’s mandate to purchase more highly regulated auto insurance was a success, at least according to the incrementalists. The insurance market is more competitive, the number of uninsured has decreased, and Californians saved $62 billion on their premiums. The fact that 18 percent of California motorists are still uninsured is merely a technical parameter that we’ll work on later.
Come on! We can get it right! We can establish a separate health care risk pool and fund it equitably through the tax system based on ability to pay, and we can provide automatic enrollment for everyone.
We must achieve reform. The last thing that we want to do is to defeat the current proposal and then walk away with nothing. But it is even more imperative for us to reject the current proposal and immediately move forward with reform that will provide affordable care for all of us.
Frankly, I’m sick and tired of listening to those who say that PNHP needs to get on board and support the public option, which is really saying that we need to support an individual mandate to purchase unaffordable plans. Those of you who were duped into supporting this model that can’t possibly work need to abandon that ship and get on board with us and our colleagues who will accept nothing less than health care justice for all.

How the Baucus Plan Screws Older People

by James Ridgeway
Baltimore Chronicle
First published in his blog Unsilent Generation yesterday, 18 September 2009

As I wrote yesterday, there are aspects of the Baucus health care reform plan that don’t bode well for Medicare recipients. But the people who stand to get screwed most by the plan are those who aren’t old enough to qualify for Medicare, but are still old enough to be discriminated against by insurance companies.

For several months, the Columbia Journalism Review has been publishing analyses of the Massachusetts health care system, which in many ways serves as a model for the current national health care reform–a “canary in the coal mine” for the rest of us. The state mandates that all residents have health insurance or face a tax penalty. And while it does provides some regulation of private insurers, it doesn’t bar them for “age rating”–setting different premium rates based on age. This doesn’t apply to most working people who are covered by group plans through their employers, at group rates. But for the self-employed and early retirees–who numbers are growing since the recession began–the costs can be devastating. CJR cites reporting by Kay Lazar in the Boston Globe, which found:

State law allows insurers to charge older people up to twice as much as younger people for the same coverage. In other states, the disparities can be even greater. One result is that more older people choose less comprehensive plans. Data from the Commonwealth Choice program, which offers state-approved private insurance, show that as enrollees grow older, more choose cheaper and less comprehensive coverage.

The main solution that’s been proposed for this problem is to make it “easier for self-employed people and retirees who are 50 to 64 to be exempted from a stiff tax penalty if they can’t afford insurance.” So rather than force insurance companies to stop discriminating on the basis of age, the state may begin “allowing” 60-year-olds to live without health insurance. So much for the great Massachusetts universal coverage model.

All of the major health reform plans that have been floated in Congress allow age-rating, and the Baucus plan endorses disparities even higher than those in Massachusetts. As the New York Times reports:

Under Senator Baucus’s plan, insurers would be permitted to charge older people five times more for their health insurance premiums than younger people. That proposal, first circulated in a Finance Committee policy options paper last spring, is a significant departure from the approaches put forth by three House committees and the Senate Health, Education, Labor and Pensions Committee. Those bills would only allow insurers to charge older people twice as much as younger ones….

According to AARP, the lobbying organization for older Americans, the number of uninsured adults between 50 and 64 grew to 7.1 million in 2007, an increase of 36 percent over 2000. Among the main reasons for the increase: higher premiums demanded of older, sicker people seeking coverage in the individual insurance market.

Supporters of the Baucus plan and the other half-measure Congressional health reform proposals made a big deal of the fact that insurers won’t be able to turn people away, or charge them more, because they have pre-existing conditions. In other words, they can’t discriminate against sick people. They also, of course, cannot discriminate on the basis of race, ethnicity, gender, and the like. This means that the only form of discrimination that will remain legal is age discrimination.

This is, of course, another sop to the insurance industry, which worries about the effect on its profit margin if it has to insure everyone. As the Times notes:

By allowing insurers to charge so much more for older, often sicker people, “You’re just using age as a proxy for health status,” said Uwe Reinhardt, an economics professor at Princeton University. He estimates that Senator Baucus’s age-rating plan would allow insurers to cover roughly 70 percent of the additional risk they’d take on by being required to accept all comers, regardless of health.

No Country for Sick Men

To judge the content of a nation's character, look no further than its health-care system.

By T. R. Reid
NEWSWEEK
Published Sep 12, 2009

“Us Canadians, we’re kind of understated by nature,” Marcus Davies told me in his soft-spoken way. “We don’t go around chanting ‘We’re No. 1!’ But you know, there are two areas where we feel superior to the U.S.: hockey and health care.”

Davies is an official of the Saskatchewan Medical Society, so it’s not surprising that he would want to extol Canadian medicine. But that feeling of patriotic pride in the nation’s health-care system is something that just about all Canadians share. They love to point out that Canada provides coverage for everybody, usually with no copay and no deductible–while the U.S. leaves tens of millions of its citizens uninsured. They love to remind us that, while the U.S. lets some 700,000 people go bankrupt due to medical bills each year, the number of medical bankruptcies in Canada is precisely zero.

Yet I wasn’t inclined to let Davies go unchallenged. I agreed that Canada does an admirable job of providing free and prompt care to anybody with an acute medical condition. But for nonemergency cases, the system often provides nothing but a long wait. Last summer I tried to get an appointment with an orthopedist in Canada to treat my aching right shoulder; the waiting time, just for an initial consultation, was 10 months. How could you be proud of that?

“You’re right,” Davies said frankly. “We keep people waiting, to limit costs. But you have to understand something basic about Canadians. Canadians don’t mind waiting for elective care all that much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.”

In that last sentence, Davies set forth the national ethic of health care in his country: medicine is not a commodity to be sold to the highest bidder, but a right that must be distributed equitably to one and all. In short, the Canadians have built a health-care system that neatly fits the Canadian character: ferociously egalitarian, but thrifty at the same time.

I found that same pattern–a health-care system that reflects a nation’s basic cultural values–everywhere I went when I traveled the world for a PBS documentary and a book about how other wealthy countries provide health care. “The fundamental truth about health care in every country,” notes Princeton professor Uwe Reinhardt, one of the world’s preeminent health-care economists, “is that national values, national character, determine how each system works.”

The design of any country’s health-care system involves political, medical, and economic decisions. But the primary issue for any health-care system is, as President Obama made clear last week, a moral question: should a rich society provide health care to everyone who needs it? If a nation answers yes to that moral question, it will build a health-care system like the ones in Britain, Germany, Canada, France, and Japan, where everybody is covered. If a nation doesn’t decide to provide universal coverage, then you’re likely to end up with a system where some people get the finest medical care on earth in the finest hospitals, and tens of thousands of others are left to die for lack of care. Without the moral commitment, in other words, you end up with a system like America’s.

Around the world, cultural influences govern much of the nitty-gritty of daily medical practice. In the Confucian nations of East Asia, doctors were traditionally expected to treat people for free; they earned a living by selling medicine to be taken once the patient went home. To this day, doctors in Japan and China do both the prescribing and the selling of medicine. And guess what? Those doctors tend to prescribe far more drugs than their Western counterparts, who don’t share in the pharmacy’s profit.

British women tend to have their babies at home; American women tend to deliver in the hospital, but go home a day or two after the birth; Japanese women remain in the hospital with the baby an average of 10 days after delivery. In Britain, Spain, and Italy, the basic rule of medicine is that people never get a doctor’s bill; health care is funded through general taxation. But just across the border, in France, patients are expected to make a cash payment for any encounter with the health-care system, even though the insurance plan will reimburse most of that copay within a week or so. The French have decided that people should be reminded on every visit that health care costs money–even if it’s the insurance company’s money.

In Germany and Austria, health insurance pays for a week at a spa, if a doctor prescribes it to deal with stress. In Britain, when I asked whether the National Health Service would provide the same benefit, my doctor laughed at the very thought of it.

But the most important influence of national culture can be seen in the most basic question facing any country’s health-care system: who is covered?

On this fundamental issue, the United States is the odd man out among the world’s advanced, free-market democracies. All the other industrialized democracies guarantee health care for everybody–young or old, sick or well, rich or poor, native or immigrant. The U.S.A., the world’s richest and most powerful nation, is the only advanced country that has never made a commitment to provide medical care to everyone who needs it.

Our lack of universal coverage has consequences. According to government and private studies, about 22,000 of our fellow Americans die each year of treatable diseases because they lack insurance and can’t afford a doctor. This generally happens to people with a chronic illness who have too much money to qualify for Medicaid, but too little to pay for the drugs and treatment they need to stay alive. Among the rich nations, this happens only in America. Likewise, the U.S. is the only developed country where medical bankruptcies can happen.

Those Americans who die or go broke because they happened to get sick represent a basic moral decision our country has made. All the other rich countries have made a different decision: they cover everybody. A French physician, Dr. Valerie Newman, explained it this way: “You Americans say that everybody is equal,” she said. “But this is not so. Some are beautiful, some aren’t. Some are brilliant, some aren’t. But when we get sick–then, yes: everybody is equal. That is something we can deal with on an equal basis. This rule seems so basic to the French: we should all have the same access to care when it comes to life and death.”

Other nations adhere to the same principle, with slightly different explanations. For Switzerland–a rich, capitalist country that didn’t create a universal health-care system until 1994–the underlying rationale is the concept of solidarite. That’s a crucial word in the Swiss vocabulary, freighted with meanings that include “community,” “equal treatment,” and “despite our differences, we’re all in this together.”

“To have a great sense of solidarite among the people,” former Swiss president Pascal Couchepin told me, “all must have an equal right–and particularly, a right to medical care. Because it is a profound need for people to be sure, if they are struck by the stroke of destiny, they can have a good health system.”

That principle seems so obvious to people in Europe, Canada, and the East Asian democracies that health officials asked me over and over to explain why it isn’t obvious to Americans as well. “The formula is so simple: health care for everybody, paid for by everybody,” a deputy health minister in Sweden told me. “You Americans are so clever. Why haven’t you figured that out?”

This formula is so basic in the other industrialized democracies that virtually all of them have included some version of a “right to medical care” in the national constitution. Nearly all European countries (the striking exception is Russia) have signed on to the European Union’s Charter of Fundamental Rights, which serves as a sort of continentwide Bill of Rights, enforceable by the courts. “Everyone has the right of access to preventive health care and the right to benefit from medical treatment,” the charter says.

The new democracies that have emerged in the two decades since the fall of the Soviet Union generally include a “right to health care” in their constitutions. The Czech Constitution, written in 1992, is typical. “The state is obliged to guarantee the right to life and the right to protection of health, and health care for all,” the document declares.

In the U.S., in contrast, neither the federal Constitution nor any state guarantees “health care for all.” Some Americans have gone to court claiming a right to care. The legal theory is that our Declaration of Independence says we all have “inalienable rights,” including a right to life, and you can’t have life without medical care to keep you alive. No U.S. court has ever bought this argument.

In the other advanced democracies, though, there’s no debate. All of them recognize a right to “health care for all” as a moral obligation. But they don’t all agree on the way to assure that right.

Some nations–Britain, Spain, Italy, and New Zealand, among others–have decided that providing health care is a job for government, just like building roads or putting out fires. In those countries, government owns the hospitals, employs many or most of the doctors, and pays the bills. That seems pretty close to what Americans think of as “socialized medicine.”

But many rich democracies–Germany, France, Switzerland, the Netherlands, Japan–provide universal coverage with private doctors, private hospitals, and mainly private insurance plans. Unlike Americans, who switch to government-run insurance (Medicare) at age 65, Germans stick with private insurance from cradle to grave. Japan has more for-profit hospitals than the U.S., and far fewer doctors on the government payroll than we do. This is universal coverage, but it’s not socialism.

Some countries–Canada, Taiwan, Australia–have a blended system, with private-sector doctors and hospitals, but a government payment system. The Canadian model–private providers, but public insurance to pay them–is the system Lyndon Johnson copied when he created Medicare in 1965. The difference is that Canada, Taiwan, and Australia provide the public insurance for everybody, while the U.S. restricts it to seniors and the disabled.

In our current debate on health care, many have warned that universal coverage will inevitably lead to “rationing” of health care. The argument overlooks a basic fact: the United States already rations health care. Indeed, every country rations health care, because no system can afford to pay for everything. The key distinction is the way rationing happens.

In the other developed democracies, there’s a basic floor of coverage that everybody is entitled to; that’s why nobody dies in those nations for lack of care. But there are limits on which procedures and which medications the system will pay for. That’s where the rationing kicks in. “We cover everybody, but we don’t cover everything,” the former British health minister John Reid explained.

In the U.S., in contrast, some people have access to just about everything doctors and hospitals can provide. But others can’t even get in the door (until they are sick enough to need emergency care). That amounts to rationing care by wealth. This seems natural to Americans; to the rest of the developed world, it looks immoral.

“Canadians don’t mind waiting for elective care all that much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.” In that one sentence, Marcus Davies laid out the ethical basis of Canada’s health-care system. The question facing Americans this fall is: what should be the ethical basis of America’s health-care system?

Reid’s Book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care was just published by Penguin Press. He was the Correspondent for Two PBS Frontline documentaries based on the book.Reid’s The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

Find this article at http://www.newsweek.com/id/215290

(c) 2009

Single Payer Activists Build Memorial on National Mall

By Russell Mokhiber
SinglePayerAction.org
September 21, 2009

Single payer activists have set up a memorial on the National Mall for the more than 44,000 Americans who die every year from lack of health insurance.

The memorial is being sponsored by Physicians for a National Health Program and Single Payer Action.

More than 3,000 American flags are planted on the mall at Constitution Avenue and 15th Street, NW, Washington, D.C.

The memorial is framed by a large, colorful banner that reads: “Every day, 120 Americans die from lack of health care. It doesn’t have to be this way. Single payer now. Everybody in. Nobody out.”

Tourists from Denmark, Israel and other foreign countries were stunned by the death toll.

“We don’t have this in Israel,” said one Israeli tourist. “Nobody dies from lack of health insurance. We have other problems.”

A Danish tourist said — “I’m from Denmark. We don’t have this problem there.”

“Each flag represents ten American deaths,” said Dr. Margaret Flowers of Physicians for a National Health Program. “Every day, we will plant 12 additional flags — representing the 120 Americans who died that day from lack of health insurance.

“We hope that this will make the deaths, which aren’t reported regularly in the papers, visible to the public and our legislators.”

“We feel a sense of urgency, because of the growing number of preventable deaths, to pass legislation that will be truly universal and control health care costs: a publicly financed national health system often referred to as ‘single payer’. We don’t see that happening currently in Congress,” Flowers said. “It is time to join the rest of the industrialized countries, to do what civilized societies do — take care of their people. We spend the most money on health care and have poor health results. Sooner or later, we will get single payer. We’re working to get it sooner — to save lives.”

A study published in the American Journal of Public Health last week found that more than 44,000 Americans die every year — 122 every day — due to lack of health insurance.

The 44,000 dead a year estimate is about two-and-a-half times higher than an estimate from the Institute of Medicine in 2002.

The Harvard-based researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

“In Canada and western Europe, the number of people who die every year from lack of health insurance is zero,” said Russell Mokhiber of Single Payer Action. “In the United States, it’s 44,000. That’s a disgrace. It doesn’t have to be this way.”

Even the most liberal health care reform bill being seriously considered by the Democrats in the House would leave 17 million people uninsured.

The bill proposed by Senator Max Baucus would leave 25 million uninsured.

That translates into about 25,000 deaths annually from lack of health insurance.

“Single payer saves lives,” Mokhiber said. “Let’s get it done.”

Mark Dudzic of the Labor Campaign for Single Payer said he’s volunteering at the memorial because “it’s important to bear witness to all of the lives that have been lost because we’re the only industrialized country that doesn’t have a humane health care system for its people.”

The memorial will be up all of this week — until 6 p.m. on Sunday, September 27, 2009.

If you would like to volunteer at the memorial, write to Dr. Margaret Flowers at mdpnhp@gmail.com