PNHP

Insurance disruptions due to spousal Medicare transitions

Insurance disruptions due to spousal Medicare transitions

Insurance Disruption due to Spousal Medicare Transitions: Implications for Access to Care and Health Care Utilization for Women Approaching Age 65

By Jessica R. Schumacher, Maureen A. Smith, Jinn-Ing Liou, Nancy Pandhi
HSR
June 2009
Objective: To assess whether a husband’s Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.
Principal Findings: After adjustment, women who experienced an insurance disruption due to their husband’s Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.
Conclusions: Despite consistent insurance coverage, the insurance disruption that accompanies a spouse’s Medicare transition has adverse access and health care utilization consequences for women.
http://www.hsr.org/hsr/abstract.jsp?aid=44347877138

Most individuals experience a sense of relief on turning 65 because they know that they have the security of being covered by Medicare for the remainder of their lives. But that relief is often tempered by concerns over the transitional problem of having a wife who is not yet 65, but who experiences a disruption in her insurance because she had been covered as a dependent on her husband’s plan. This study demonstrates that such disruptions can have adverse consequences for health care.
How would the current reform proposals address this problem? Likely she would be mandated to purchase an individual plan through the insurance exchange, probably at a higher premium since plans would be allowed to use age as a factor in setting rates. This could be quite expensive just at a time that the couple is trying to pull together their financial plans for their retirement years. Also since almost all private health plans assess financial penalties for failure to use their contracted providers, she could lose the choice of continuing to use her current health care professionals. What would happen if she has a serious medical problem and has already initiated a complicated medical regimen (e.g., cancer chemotherapy, radiation, and staged surgery)?
Should Congress include in the reform legislation a measure that would cover the spouse under Medicare once the eligible individual turns 65? If so, should the taxpayers fund that coverage, even if the spouse is 32? If, instead, a premium is to be paid, would it be based on the actuarial value of a risk pool composed of high-cost retirees and individuals with long-term disabilities (i.e., the current Medicare program)? If the husband is leaving an employer-sponsored plan, would the former employer be required to continue the spouse’s coverage to avoid transitional disruptions? If so, who pays and how much?
We will always face these issues and many more as long as Congress insists that we are each mandated to finance our health care through our fragmented, dysfunctional, multi-payer insurance system.
All we really need to do is fix Medicare, and then make enrollment automatic for everyone. But then that would break the bond of trust that President Obama and the members of Congress have established with Karen Ignagni. That seems to be a much stronger bond than they have with the other 306 million of us.

Insurance disruptions due to spousal Medicare transitions

Insurance Disruption due to Spousal Medicare Transitions: Implications for Access to Care and Health Care Utilization for Women Approaching Age 65

By Jessica R. Schumacher, Maureen A. Smith, Jinn-Ing Liou, Nancy Pandhi
HSR
June 2009

Objective: To assess whether a husband’s Medicare transition leads to insurance disruptions for his wife that impact her perceived access to care, health care utilization, or health status.

Principal Findings: After adjustment, women who experienced an insurance disruption due to their husband’s Medicare transition had a greater probability of experiencing a change in usual clinic/provider (71 percent), delaying filling or taking fewer medications than prescribed because of cost (75 percent), going to the emergency room (52 percent), and had lower average mental health scores than women who did not experience an insurance disruption.

Conclusions: Despite consistent insurance coverage, the insurance disruption that accompanies a spouse’s Medicare transition has adverse access and health care utilization consequences for women.

http://www.hsr.org/hsr/abstract.jsp?aid=44347877138

Comment:

By Don McCanne, MD

Most individuals experience a sense of relief on turning 65 because they know that they have the security of being covered by Medicare for the remainder of their lives. But that relief is often tempered by concerns over the transitional problem of having a wife who is not yet 65, but who experiences a disruption in her insurance because she had been covered as a dependent on her husband’s plan. This study demonstrates that such disruptions can have adverse consequences for health care.

How would the current reform proposals address this problem? Likely she would be mandated to purchase an individual plan through the insurance exchange, probably at a higher premium since plans would be allowed to use age as a factor in setting rates. This could be quite expensive just at a time that the couple is trying to pull together their financial plans for their retirement years. Also since almost all private health plans assess financial penalties for failure to use their contracted providers, she could lose the choice of continuing to use her current health care professionals. What would happen if she has a serious medical problem and has already initiated a complicated medical regimen (e.g., cancer chemotherapy, radiation, and staged surgery)?

Should Congress include in the reform legislation a measure that would cover the spouse under Medicare once the eligible individual turns 65? If so, should the taxpayers fund that coverage, even if the spouse is 32? If, instead, a premium is to be paid, would it be based on the actuarial value of a risk pool composed of high-cost retirees and individuals with long-term disabilities (i.e., the current Medicare program)? If the husband is leaving an employer-sponsored plan, would the former employer be required to continue the spouse’s coverage to avoid transitional disruptions? If so, who pays and how much?

We will always face these issues and many more as long as Congress insists that we are each mandated to finance our health care through our fragmented, dysfunctional, multi-payer insurance system.

All we really need to do is fix Medicare, and then make enrollment automatic for everyone. But then that would break the bond of trust that President Obama and the members of Congress have established with Karen Ignagni. That seems to be a much stronger bond than they have with the other 306 million of us.

'Congress doesn't know we've been arrested'

St. Mary's doctor says single-payer health care option being ignored; Hoyer said it's been heard

By JAY FRIESS
Staff writer
South Maryland News, SoMdNews.com
Friday, July 3, 2009

Leonardtown psychiatrist Dr. Carol Paris will not be required to complete community service for disrupting a U.S. Senate hearing May 5 on health care reform. So long as she doesn’t break any laws for nine months, the charge could be purged from her record.

Paris said Wednesday that the U.S. attorney originally wanted her to do 40 hours of community service, but dropped the demand Tuesday, since Paris lives more than an hour outside of Washington, D.C.

Five of her fellow protesters must complete community service.

“It’s a total crock,” Paris said of the plea deals. “What those people do for a living is a community service. Their protest was a community service.”

Paris and 12 other advocates of a single-payer health care, sometimes known as “Medicare for all,” were arrested for disorderly conduct after not being given an official opportunity to speak at the hearing conducted by Sen. Max Baucus (D-Mont.). Paris and seven fellow members of Physicians for a National Health Program, a nonprofit advocacy organization, resorted to making statements from the audience without being recognized. Five other members of the organization were arrested at a subsequent hearing May 12.

“I interrupt this so-called public hearing to bring you the following unpaid, political announcement: put single-payer on the table. My name is Dr. Carol Paris, and I approve this message,” Paris proclaimed before she was led away by police and charged with disorderly conduct.

Paris’ protest and subsequent arrest was recorded and uploaded to YouTube.com. Paris said that the national media has ignored the arrests, and added, “Congress doesn’t even know we’ve been arrested.”

Paris said Wednesday that of the 41 people invited to speak at the May hearing, including representatives from insurance and drug industry groups, none addressed nationalizing health care. Paris charged that Baucus purposely banned single-payer advocates from the hearing.

“They represent their lobbied interests; they do not represent their people,” Paris said of the Senate Finance Committee, which is drafting health care reform legislation.

According to Open Secrets, an online database of congressional contributions maintained by the Center for Responsive Politics, Baucus took $3 million in contributions from health care interests in the 2008 election cycle and has already taken $2 million from the same interests in the 2010 cycle. Health interests constitute the second-highest contributing sector for Baucus. The senator’s fifth-highest donor in the last five years has been the health insurance company Blue Cross & Shield.

Paris also scolded Rep. Steny Hoyer (D-Md., 5th), House majority leader, for not pushing debate on a single-payer bill sitting dormant in the House of Representatives. She said that the public deserves to be educated about the issues. “All they know is that Steny Hoyer says that it’s not politically feasible,” Paris said.

Hoyer also counts the health industry as his second-highest donor, taking $910,000 in the 2008 cycle and $82,000 in the current 2010 cycle. The National Association of Retail Druggists has been his fifth-highest contributor in the last five years.

“Congressman Hoyer is committed to listening to the opinions and suggestions of his constituents as he always has,” Hoyer spokeswoman Katie Grant said Thursday in a prepared statement. “He will continue working with both his constituents and his fellow Members of Congress to bring a health care reform bill to the House floor that has broad support and increases access, contains costs, improves quality, and preserves choice of plan and doctor.”

Hoyer’s office said that the House Education and Labor committee held a hearing on the single-payer option. Proponents and experts testified before the Education and Labor; Energy and Commerce; and Ways and Means committees last week.

Paris said she is not looking to be arrested again, but she vowed to continue to advocate for national health insurance. She has drafted a journal article reviewing the corrupting effects of profit motive on health care.

“I have nothing to gain from this,” Paris said. “I will continue to do this, because I want people to be informed. What I see is that people are not informed about the issue.”

Paris said she has received words of encouragement from the community, including a supportive letter from Dr. Chinnadurai Devadason, Charles County’s health officer. She has been invited to give a presentation to the Minority Outreach Coalition on the evening of July 10 at St. Mary’s Church of Christ in California.

jfriess@somdnews.com

http://www.somdnews.com/stories/07032009/entetop155723_32202.shtml

Obama health czar directed firms in trouble

DeParle made millions from companies under federal investigation

By Fred Schulte
MSNBC
Investigative Reporting Workshop, American University
Thurs., July 2, 2009

Nancy-Ann DeParle, President Barack Obama’s health policy czar, served as a director of corporations that faced scores of federal investigations, whistleblower lawsuits and other regulatory actions, according to government records reviewed by the Investigative Reporting Workshop at American University.

Several of the companies were investigated for alleged kickbacks or engaging in other illegal billing schemes, while others were accused of serious violations of federal quality standards, including one company that failed to warn patients of deadly problems with an implanted heart defibrillator. Several of the cases ended with substantial fines paid to the federal government, even though the companies admitted no wrongdoing.

Since leaving her government job running Medicare for the Clinton administration, DeParle built a lucrative private-sector career. Records show she earned more than $6.6 million since early 2001, according to a tally by the Investigative Reporting Workshop.

Much of that corporate career was built at companies that have frequently had to defend themselves against federal investigations. After leaving government, DeParle accepted director positions at half a dozen companies suspected of violating the very laws and regulations she had enforced for Medicare. Those companies got into further trouble on her watch as a director.

Now she’s back in government as a leading voice in deciding the shape of health care reform. Named by Obama in March as director of the White House Office of Health Reform, making $158,000 a year, DeParle is the point person in pushing for the administration’s plans for changing health care and the ways Americans pay for it — changes in which her former companies have a great deal at stake.

Critics see DeParle’s re-emergence as a classic case of Washington “revolving door” syndrome, despite Obama’s suggestions that he would shut that door.

The administration faces a “balancing act,” said Steve Ellis of the nonpartisan Taxpayers for Common Sense. Obama must find leaders with the proper expertise, but who are “not so conflicted that they cannot engage in all facets of the debate.”

Advocates of a “single-payer” coverage plan say that DeParle may be indebted to the companies she served, and more broadly to the health care industry.

“This woman owes her fortune to the corporations that she is making decisions about,” said Dr. David Himmelstein, an associate professor of medicine at Harvard University and a co-founder of Physicians for a National Health Program.

“She cashed in really big on her previous role in government and made millions and millions of dollars. Then she divests and all of a sudden she’s Snow White. It’s ridiculous.”

Among DeParle’s corporate connections:

* DaVita Inc., which owns and operates kidney dialysis centers, has been the subject of several government probes into its billing and drug-prescribing practices, most recently in December by Justice Department investigators in Georgia. DeParle joined the DaVita board in May 2001 and resigned in July 2008 “to devote more time to her other business activities,” according to the company. She earned more than $2 million in compensation and stock sales, according to records at the Securities and Exchange Commission.

* Boston Scientific Corp. reported to the SEC that it received five state or federal subpoenas during 2008, including ones from the Justice Department and Health and Human Services, which oversees the Medicare agency. In addition, Defense Department criminal investigators are looking into the company’s “marketing interactions” with doctors at a U.S. Army hospital in Tacoma, Wash. DeParle joined the Boston Scientific board in April 2006 and resigned on March 4 of this year, two days after she was appointed to the White House post. She earned more than $1.4 million in compensation and stock sales from her years at Boston Scientific and a company it bought, the Guidant Corp.

* Guidant, which already was in legal trouble for failing to disclose 12 patient deaths when DeParle joined the board in 2001, has since then faced new problems. After a college student died in 2005 when his implanted defibrillator failed on a biking trip, his doctor told Congress that Guidant officials had known of similar problems for three years, but failed to tell the public.

Five of the corporations whose boards DeParle served on have paid a total of $566 million since 2003 to settle fraud or product liability cases, often involving tax dollars paid by Medicare.

Four signed “corporate integrity agreements” in which they promised to tighten oversight of their billing practices in exchange for the government agreeing not to take legal action to kick them out of the Medicare program.

“These raise eyebrows,” said Ellis, of Taxpayers for Common Sense. “These are things that have to be considered and evaluated.”

The White House did not make DeParle available for an interview about her corporate ties. Her spokeswoman, Linda Douglass, said the White House would not have time to answer questions about DeParle’s actions as a director. DeParle also declined interview requests from msnbc.com, which is co-publishing this article with the Investigative Reporting Workshop.

A director’s responsibility

There is no reason to think that DeParle was directly involved in any of the actions that led to the investigations and sanctions. DeParle was a member of the board of directors of these companies, not the chief executive officer managing day-to-day operations. It is rare for directors to be held legally accountable for illegal dealings by management.

However, the 2002 Sarbanes-Oxley law, passed by Congress after the scandals at Enron and other companies, requires directors to be more aware of what is happening inside companies. Federal guidelines tell directors they should exercise even more oversight in health care firms.

Michael W. Peregrine, a corporate compliance lawyer in Chicago, said that while board members aren’t obligated to “ferret out wrongdoing,” they need to question management once they learn of regulatory problems and to “make sure something is being done about it. The board has to ask, ‘What the hell’s going on here?'”

At three companies — Guidant, DaVita and Specialty Laboratories — DeParle was not only a director but also served on board committees responsible for monitoring the companies’ compliance with laws and regulations.

Publicly traded companies must disclose to shareholders the existence of investigations, enforcement actions or lawsuits that could affect their earnings. These filings, made with the Securities and Exchange Commission, often are short on specifics, including when the conduct that’s under investigation allegedly occurred. These investigations typically drag on for years.

It’s therefore difficult to say in some cases whether DeParle’s board service coincided with the company’s suspicious conduct, or whether some of the conduct preceded her service but only came to light during her service.

In a few additional cases, DeParle joined companies that had already gotten into trouble.

For example, DeParle agreed to join the board of Guidant just days after it acknowledged it had covered up the deaths of 12 patients and more than 2,000 injuries caused by a faulty surgical device. She was on the board when the company pleaded guilty to 10 felony charges in the case, and paid $92 million in fines. The apparent cover-up in the separate case involving the implanted defibrillator came to light when DeParle had been on the board for two years.

And she joined the board of Boston Scientific about a year after it had paid $74 million to settle a federal criminal investigation into the company’s delay in recalling a faulty heart device. No charges were brought, and the company no longer sells the product, called a stent. It also denied wrongdoing as part of the settlement with prosecutors.

Peregrine, the regulatory compliance lawyer, said potential directors should be “cautious” about joining the boards of companies with a history of clashing with regulators. Board members need to satisfy themselves that the organization has developed “a culture of compliance” with laws, he said.

‘A dedicated public servant’

DeParle resigned her corporate board positions upon taking the White House position, according to a financial disclosure form dated May 13 but only released by the White House on June 12. A handwritten note on the first page says that, as of June 4, “all conflicting assets have been divested.”

Her spokeswoman said DeParle has recused herself from any matters that might affect these companies, and has sold her stock in them at a “fairly substantial financial loss to herself and her family.” DeParle has “come into government with the understanding it would require a financial sacrifice. She is in complete compliance with all ethical requirements of the administration,” Douglass said.

“She gave it all up to come and work in a tiny cramped office on one of the most important issues the country is dealing with,” Douglass said. “She’s working seven days a week, not seeing her children and working incredibly long hours. She’s doing this because she is a dedicated public servant.”

Update: Douglass told The Washington Post that, if an investigation arose during DeParle’s tenure on a board, she pressed executives to fully comply. No details were given. And before joining any board, Douglass said, DeParle “did extensive due diligence, talking with other board members, lawyers and others familiar with the company.”

The public may never get a full accounting of her actions on corporate boards. Although DeParle is the point person on Obama’s effort to overhaul health care for all Americans, she didn’t have to face questions at a Senate confirmation hearing, because she’s a White House staffer, not a Cabinet official.

DeParle, 52, was the first woman to be president of the student body at the University of Tennessee, a Rhodes Scholar, and graduated from Harvard Law School. She ran the Medicaid program in Tennessee before going to Washington. Since leaving the Clinton administration, in addition to serving on corporate boards she was a managing director of a private equity firm that invested in health care companies, a trustee of the Robert Wood Johnson Foundation, and held fellowships at two universities.

‘Makes you more valuable’

Growing concern over fraud in the health care industry has led federal officials in recent years to warn directors that they must make “good faith” inquiries into business practices, particularly when there’s reason to suspect wrongdoing. Federal officials are requiring more rigorous oversight by board members of the effectiveness of a company’s formal plan for complying with federal laws and regulations.

“Having government experience is a plus. It is one of the things that make you more valuable,” said Lynn Shapiro Snyder, a Washington lawyer and corporate defense counsel.

In DeParle’s case, four corporations paid her a total of $533,189 last year for serving as a director, according to SEC filings. The year before, she made $549,322 from three board positions. Of the $6.6 million she made from 2001 to 2009, about $2.2 million came from directors’ fees, and $4.4 million from stock options and trades. Her DaVita shares made her at least $1.8 million, and she made $1 million when Triad Hospitals Inc., a Texas company, was sold in 2007.

DeParle’s White House financial disclosure form shows that in 2008 she received $1 million in salary and bonus from CCMP Capital Advisors, LLC, a private equity firm she joined in August 2006 as a managing director helping oversee health care investments. Those interests included a Medicare managed care plan and a start-up hospital chain. She resigned from the firm in March.

Her White House biography mentions that she had served on corporate boards, but doesn’t name any of them. Though it dwells on her government career, it states that she “also brings a unique industry perspective from her work in the private sector.”

The investigations and lawsuits are at odds with DeParle’s reputation in Washington as a progressive, highly respected health policy analyst. During the late 1990s, when she ran Medicare, she pushed hard to raise medical quality standards and to clamp down on fraud and waste in the massive federal health plan for the elderly.

“In my experience, she’s the one administrator who really was tuned into the fraud issue,” said William J. Mahon, a former director of the National Health Care Anti-Fraud Association. “She distinguished herself in putting fraud on the agenda.”

Other companies with much to gain

Whether DeParle’s time in the private sector will influence the shape of health care reform remains to be seen. But there’s no doubt that the decisions will have significant impact on the corporations she formerly served. The Obama administration’s decision to spend billions of dollars promoting the use of electronic medical records offers an example.

In an April 15 media briefing in Washington, DeParle mentioned electronic medical records twice, first saying that an electronic system will help prevent medical errors and ensure that patients get “the right treatments.”

In response to a question, she added: “We want to incentivize physicians to use electronic medical records in a meaningful way for better treatment, better care, more convenience, better administration in their offices.”

Nobody mentioned her lengthy relationship with the Cerner Corporation, a major manufacturer of electronic medical records software based in Kansas City. From May 2001 until the day after her White House appointment, DeParle served on the board at Cerner, which has not reported any investigations into its finances or business dealings in recent years.

DeParle earned at least $680,000 from director’s compensation and stock options while she was on the Cerner board.

Mia Steinle contributed to this report.

Left out of the discussion

Single-payer advocates still trying to be heard

By Gregg Blesch
Modern Healthcare
Jun 8, 2009

Lawmakers trying to get sweeping health care legislation passed this summer have made a point – and a show of keeping disparate industry and advocacy groups engaged in the discussions. The only ones with no seat at the large table are those who believe private insurance companies should lose theirs, but supporters of a single-payer health system are still fighting to be heard.

Last week, researchers who are members of Physicians for a National Health Program publicized two studies they say bolster the argument that any system that includes insurance companies is doomed to fail in both of its primary pursuits: to reduce costs, both to taxpayers and consumers, and provide every citizen with quality coverage.

David Himmelstein, an associate professor at Harvard Medical School and PNHP member, was the lead author on one study and co-author on the other. He said it’s a coincidence that they arrived the same week and at a time when they and other advocates of their cause are trying to storm the gates on a process they’ve been shut out of. “We have no way of dictating journal schedules,” he said.

One study, appearing in the American Journal of Medicine, finds that 62 percent of American bankruptcies in 2007 had a medical cause. The research is a sequel to results published in 2001 that about half of bankruptcies examined were caused in part by medical bills or illness, and the finding has been repeated often by advocates of health care reform, including on several occasions President Barack Obama.

“We did the study back in 2007- planned it in 2006 – and nows the time to publish,” Himmelstein said. “We’re pleased it comes out at a time these matters are of great interest.” The study also finds that a majority of those debtors had health insurance when they filed. “What’s on the table in D.C. does virtually nothing for those people.”

The New England Journal of Medicine, meanwhile, published a letter from Himmelstein and two other PNHP members that reports a finding that several life and disability insurance companies still hold about $4.5 billion worth of tobacco stocks. The letter begins, “The Obama administration is proposing a major overhaul of the U.S. health care system, and the insurance industry is poised to play a major role in the process. Insurance firms, like any business, are driven by profit, and this fact compromises any health care plan that includes them.”

A handful of protesters were arrested last month after complaining during a Senate Finance Committee hearing on health care reform that Chairman Max Baucus (D-Mont.) convened a 15-member panel that included two people speaking for the insurance industry but no one arguing for a single-payer system.

On June 3 Baucus met with single-payer advocates, including members of the California Nurses Association/National Nurses Organizing Committee. The nurses union reported that Baucus agreed to hold a hearing on their proposal and otherwise treat it seriously. Baucus spokeswoman Erin Shields responded to a query about those claims with a statement that didn’t directly address them.

“Sen. Baucus met privately with single-payer advocates and discussed their shared goals of providing quality, affordable health care to every American,” Shields said. “Sen. Baucus asked them to work together with him to pursue that goal this year.”

Himmelstein, who also attended the meeting, said he was not convinced Baucus is about to let him and his allies into the circle. “It left me encouraged he felt like he had to meet with us, but he’s not prepared to rectify it yet,” Himmelstein said. He added, “Pressure works, but we haven’t applied enough pressure yet. We don’t have money, so the only other thing we have is mobilizing people, and that we have lots of.”

Copyright Crain Communications, Incorporated Jun 8, 2009

Medical bankruptcy: A South Florida case study

By Bob LaMendola
South Florida Sun-Sentinel
June 23, 2009

Self-employed with no health insurance, Dorothy Carmona began descending into debt in 2004 when she had a stroke. Next, the housing crash ruined her title business. Then last fall she was diagnosed with aggressive lung cancer.

It all came to a head this month. With a lender about to foreclose on her Pembroke Pines townhouse and years of medical bills now making up more than half the $125,000 she owes other creditors, Carmona filed for bankruptcy. Days later she learned the cancer had worsened.

“It’s been one nightmare after another,” said Carmona, 48, a single mother whose teenage daughter lives at home. “I’m ruined. I have nothing. They tell me I have five months to live. Right now I’m in a frightened mode. I don’t know what’s going to happen to me.”

Carmona is the face of a growing national issue: Health care costs are driving people to financial ruin. The problem fuels a push to extend medical coverage to the roughly 50 million uninsured and under-insured Americans.

A Harvard University study this month found that 62 percent of U.S. bankruptcy cases in 2007 were caused by or inflamed by medical bills. That’s up from 50 percent in 2001 and 8 percent in 1981.

No one tracks the causes of South Florida bankruptcies, but court figures show the recession has sent the number of filings skyrocketing in the past year. Cases in Palm Beach County are up 57 percent this year compared with the first four months of last year; Broward County cases are up 46 percent.

“Medical debt often puts them over the edge into bankruptcy,” said Boca Raton bankruptcy attorney Les Auerbach.

Not only are uninsured patients on the hook for the entire bill, they often are charged more than patients whose insurers negotiate lower prices from hospitals and doctors. While providers usually will set up payment plans, many uninsured patients cannot dig out for years, if ever. The same outcome can hit insured people if they or family members get sick.

“They get sick, they can’t work, they lose their jobs and the medical coverage runs out. They can’t pay their mortgage and they can’t pay their doctor,” said Eric Klein, a Boca Raton attorney.

“I see it every day,” said Robert Bigge, a Wilton Manors attorney. “They have the big bills. The drugs, the tests, the [doctor visits]. These people are getting nickeled and dimed to death.”

Carmona has been juggling bills for years. Her mini-stroke in 2004 was not serious but left her with big IOUs to Memorial Hospital West and doctors, to whom she still owes $11,000, her bankruptcy filing shows.

As she struggled to keep up, she said, her credit card bills began piling up. She took out a second mortgage on her modest townhouse in Tanglewood Lakes. When the tanking economy crippled her business, she was able to find a job at a title agency. But she said she wasn’t there long enough to qualify for health coverage before the cancer struck.

She had surgery, radiation and chemotherapy. This time the bills were much larger: $47,000 from Memorial Healthcare System and thousands more from doctors. She had to go on disability, but her $1,000-a-month check makes her ineligible for Medicaid.

“I was borrowing from Peter to pay Paul and keep everything going,” Carmona said. “It just snowballed. Everything goes totally out of control and [debts] ruin your credit.”

Meanwhile, the value of her home fell, so she owes $113,000 more than it’s worth. With foreclosure days away, she filed bankruptcy so she can stay in her home while the lender goes through a few more months of legalities before she will have to leave.

How common are cases like Carmona’s?

The Harvard Medical School study examined 2,300 randomly chosen bankruptcy cases around the country. The researchers counted them as medically related if debtors said illness or medical bills forced the bankruptcy, if they had $5,000 of medical debt, if they mortgaged a house to pay medical bills or if they missed two weeks of work out sick.

South Florida bankruptcy attorneys said the study counted some people for whom medical bills are only part of the problem. They said only a fraction of their cases were directly caused by medical bills, and that the economy and housing market are the biggest reasons for bankruptcy here.

Even so, the attorneys and study co-author David Himmelstein, an associate professor and physician, agreed that a serious illness carrying a few thousand dollars of bills can push people into bankruptcy.

“The disappointment of losing my home is the hard part,” Carmona said. “I bought it as a single mom and I was very proud of it. I was there 12 years. A couple more months and I’ll have to be out of here. That will be a bad day.”

Bob LaMendola can be reached at blamendola@SunSentinel.com or 954-356-4526 or 561-243-6600, ext. 4526.

http://www.sun-sentinel.com/sfl-medical-bankruptcy-062309sbjun23,0,7306845.story

A doctor fights for a single-payer plan

By Elizabeth Strother
The Roanoke Times
June 28, 2009

Dr. Janice Gable knows a lot of uninsured Americans. They became part of her family back in Konnarock, a village in the Appalachians where the mountains of far Southwest Virginia roll seamlessly into Tennessee and North Carolina. She practiced medicine there for 34 years.

Those years made Gable an ardent advocate for health care reform — and no half-measures, either.

She thinks nothing less than a national single-payer, private-provider system like Medicare is needed to replace one that delivers the costliest health care in the world, gets far from the best results and leaves so many hard-working people uninsured.

She knows their lives.

“In Konnarock,” she says, “people mostly took care of the disabled at home. But for someone to quit her job at the factory to stay home and take care of Dad — well, she can’t have health insurance.”

Then there are people like Roscoe and Vicki, the husband-wife auto mechanics who were self-employed, and so had to make a choice: “either have no insurance, which is how they handled it, or be self-insured,” which they couldn’t afford. “They left,” Gable mourns. “They had to close the garage to get jobs so they could get insurance.”

Farmers, who are also self-employed, “they’re pretty much taken care of by the wife going to work in the factory.”

Even having workplace insurance, though, doesn’t necessarily insure against financial ruin because of high deductibles and low caps on benefits. Gable will explain to anyone who will ask:

“One company had insurance with a $500 deductible. That’s the same as having no insurance. Then it pays $10,000, and it’s done.” This for workers who were bringing home $100 a week.

“When I first went there, it was $80 a week.”

That was in 1971, when Gable was a new physician. She and her husband, fresh out of seminary, had intended to work in a foreign mission, but instead landed in Konnarock, he as a pastor, she as a medical missionary. It was a sort of homecoming: The Lutheran church had sent her father-in-law there as a minister in 1939.

“There are 400 [post office] box holders in Konnarock,” Gable tells me. “I had 5,000 patients. I saw people from Bristol to Wytheville, from Independence and from Jefferson, North Carolina” and a list of other places, known to few outside the region, which she rattles off at breakneck speed.

Four years ago, she left for Northern Virginia, in her second and finally successful effort to leave behind the all-consuming life of a rural doctor in a high-poverty area.

“I hadn’t been able to go to a museum — to have a day when there was no doctoring on my mind. I had been divorced 10 or 15 years. … My 60th birthday was staring me down.” Then one day, while going through the office mail, “this recruitment letter was there.”

She had thought to leave earlier, after ballooning administrative costs forced her to cut an associate she had taken on for a couple of years.

“There are more than 1,300 different for-profit insurance companies in America,” she notes, thinking back on her desperation. “Even for a missionary doctor, a lot of money comes through the private insurance system. And I was trying not to die with my boots on.”

Gable sent a letter to box holders telling the community that, unless she could get help, the practice would close.

Working with Rep. Rick Boucher, people launched a letter-writing campaign that succeeded in getting her medical mission designated as a nonprofit community health center, eligible for government funding.

In 2002, she essentially donated her practice to Stone Mountain Health Services. “They enabled us to offer veterans services,” she explained in an e-mail following up on our phone conversation, “and they put mental health in place.” The corporation took over administering the practice, which it does still, and she started drawing a salary.

Still, Gable says, “I was about on my last leg in Konnarock.”

Now she works in Northern Virginia, where she is the recently promoted medical director of Greenspring Village, a 2,000-person retirement community with a 200-bed nursing home. The community has a medical staff of six doctors, three nurse practitioners, a podiatrist and a mental health counselor. She loves it, loves her new life.

At age 60, “I came to practice earning some money,” she says jokingly. “I still work 12 to 14 hours a day, but I’m not on call. The doctors I work with have no idea what a hard doctoring job is.” In Konnarock, “I was on call all the time — I was on call when I was in labor.”

A good chunk of her heart is still there, though she hasn’t been able to bring herself to return even for a visit. She stays connected by e-mail.

“I hear from people there every day. Sometimes they ask for advice; some are just my friends telling me about households. At least half have had a layoff in their family.”

Despite the hard times, she says, “People don’t even have the picture that this is coming down now: Something is going to happen on health care reform.”

She is at odds with Boucher over what that something should be.

Since the mid-1980s, she has been a member of Physicians for a National Health Program, which advocates a single-payer system. In her new life, she says, “I’m just killing myself for the cause.

“I thought I’d get out of my 24/7 job down there. Now, when I’m not in my garden or at my job, I’m working for health care reform.”

“My ask is: ‘Everybody ask Congressman Boucher to support H.R. 676 — Medicare for All.’ The answer from Boucher,” she says ruefully, “is ‘political feasibility.'”

Which is what he talked to me about in a phone call sandwiched between House votes one recent Friday.

“We have an urgent need to assure every person in this country has affordable access to health care,” Boucher agreed. “Nowhere is the need any greater than in my district,” Virginia’s 9th.

“Janice is interested in the Conyers bill, which outlaws private insurance. That is simply not politically feasible.”

Boucher said he backs President Obama’s call to reform the system by building a broad base of support and working “to the maximum extent possible to build reform on the existing base of insurance we have, private and government.”

Gable would eliminate the private payers to improve efficiency and quality — and fairness.

What she sees as insurance industry propaganda about health care rationing in other countries carries no truck with her.

“We ration care” in this country, she says. “Those who can’t afford it can’t get it.”

She points out that Medicare, a single-payer system, successfully cares for elderly and disabled people while keeping administrative costs to 3 percent. Private, for-profit insurers, she says, have administrative costs of 24 to 30 percent; they spend a lot of money determining who not to insure: people most likely to get sick.

“We need a different kind of rationing — because we can’t have everything — rationing based on best practices.”

“I’ve been very happy with my decision to come up here,” she tells me by phone, but she hasn’t left the Appalachians behind. “I’m going to be a voice for what the people in Konnarock need.”

“I have written on my refrigerator on a sticky Post-It: ‘90,000 federal lobbyists’ in the city I now live in, Washington. I saw it in Washingtonian magazine.

“It’s a reminder of what we’re up against.”

Strother is a member of The Roanoke Times editorial board.

Credit: The Roanoke Times, Va.

Britain's National Health Service: Simple, sensible and civilized

A former NHS patient has some advice for Americans skeptical of single-payer, government-run healthcare: You'll get over it

By Clancy Sigal
Opinion
Los Angeles Times
July 5, 2009

For the first couple of years I lived in Britain, I was an illegal immigrant from the United States, visaless with an expired passport and looking over my shoulder all the time. Even so, from the very first day I arrived at Victoria Station in London, suffering from bronchitis, I was accepted in the NHS — the national health scheme, we called it — no questions asked and no ID required.

After I’d become a legal resident, I asked my doctor why he had taken me, almost literally off the boat, with so little fuss. Weren’t foreigners a drain on his time and the National Health Service? He shrugged. “If you come here with a contagious disease, we don’t want you infecting the rest of us. So of course we give you medical care. Purely selfish on our part.”

For three decades I used and, being of a hypochondriacal nature, exploited the British medical system without paying a farthing except for the taxes taken out of my wages as a working journalist. And that single-payer, socialistic, government-run, bureaucratized, heavily used, nationalized health system served me — and 50 million others — very well. In need, I saw many doctors, with no money ever changing hands. There was nothing to sign, hardly any papers to shuffle. My primary-care physician ran his “surgery,” his office, with the help of only one receptionist whose job it was to arrange appointments.

My doctor’s waiting room in his storefront office was by American standards shockingly casual, even a trifle seedy. In what was then a rigid class society, the waiting room was also a lesson in democracy where duchesses and dustmen, old and young, rich and poor, waited their turn. It wasn’t perfect. There was the occasional misdiagnosis, crowded hospital ward, sleepy student nurse. But it worked.

It was all free, including specialists, and I came to believe that healthcare is a right, not an entitlement I had paid for. This “free” part sometimes puzzled my visiting American friends. When they got ill in London, I’d send them to my doctor, who would smile bemusedly when offered money. Did they appreciate this? Hardly. “Your doctors,” they’d say, “can’t be much good, can they?”

Is this too rosy a picture of single-payer, government-run healthcare? Maybe. Over the years, an underfunded, over-bureaucratized, increasingly privatized NHS has in some areas turned into a shadow of its former vibrant self.

Perhaps I was lucky to arrive so soon after World War II, when a traumatized, bomb-weary public was in no mood to revisit a prewar history of medical deprivation and the humiliation of means testing. Slowly, over time, by argument and debate, a consensus had been achieved, by Conservatives and Labor alike, that, in the words of Edward VIII as Prince of Wales when he first saw the grinding poverty of the unemployed, “something must be done.”

Recently, the American Medical Assn. responded with skepticism to President Obama’s plea for healthcare reform. In Britain, too, the massed ranks of the medical profession at first fought bitterly against a “socialized” service covering all from cradle to the grave. But Labor’s health minister, a firebrand from the mining valleys, Aneurin Bevan, brought them into line with a mixture of enticements and threats.

The NHS was, and is, a classically English compromise, in which individual doctors are independent contractors paid by the government according to the number of their patients. Doctors are free to remove patients from their list, and patients are free to go elsewhere. Once ideology was laid aside and the system got working, it was actually quite simple.

Once launched, in an astonishingly short time, a matter of a year or so, the NHS was accepted by even its worst enemies — the doctors and the Conservative Party — as indispensable and a civilized way of dealing with life, illness and death.

Does that sound so awful?

Clancy Sigal is a writer and former BBC broadcaster who lives in Los Angeles.

Single Payer Health Care

By Art Edelstein
Vermont Business Magazine
Brattleboro
Jun 2009. Vol. 37, Iss. 7; pg. 46

Dr Deborah Richter, a Cambridge-based family practice physician, is also chair of Vermont Health Care For All, a group advocating for publicly financed universal health care system, also known as single payer.

“Every single study of single payer has shown we can cover every Vermonter with comprehensive coverage for less money then we are spending in total now,” she argues.

She points to a bill in the US Senate sponsored by Senator Bernie Sanders that will allow states to serve as labs with their own universal health care systems.

“Bernie wants to have Vermont be first state for publicly financed health care,” she said, noting that this bill is “the most fiscally conservative model being proposed.”

Single payer, asserts Richter, “eliminates an entrenched entity. Insurance companies are not needed under this model. They are obsolete.”

According to her, “they no longer protect us from bankruptcy and to get the care we need, and they create enormous bureaucracy, but are very powerful and influential in Congress.”

Some doctors, she notes, are not in favor of single payer. “The specialists running the AMA, are against this as they are doing quite well financially as it is.”

Physicians won’t be leaders in this issue, she says, because people doing well in the status quo fight to keep it the way it is.

She sees single payer as helping to “create an enormous economic stimulus because middle class families will have more money in their budgets.”

Currently, she explained, “Vermonters pay every single penny of the health care dollar which is now $4.8 billion from either out of pocket expenses, premiums, or taxes, which all add up to the total.”

These expenses, she says, are adversely affecting business and the middle class.

“If we progressively financed health care we could inject an enormous economic stimulus into the economy. We would have to find the fairest taxes to pay for health care.”

The recent declaration by national insurance companies and some business groups to reduce costs does not get raves from Richter. “Who’s going to hold them accountable for cost cutting, its non binding?

“I don’t think it will do any good. You need to turn it into a German system with multiple payers, they are not for profit.”

But to do that, she believes “it would take all the fun out of it for insurance companies and they won’t go for that.”

Richter sees the solution in establishing “a global budget for the whole health care system with uniform reimbursements for hospitals and physicians and drug uniformity and new health planning.”

Richter calls Catamount Health, the state’s attempt to insure all Vermonters, “a fancy band aid not working.” She says the program “is costing us more, and most can’t afford the premiums. It would have been cheaper for taxpayers to pay directly for the care these people receive.”

Copyright Boutin-McQuiston, Inc. Jun 2009

‘Congress doesn’t know we’ve been arrested’

St. Mary’s doctor says single-payer health care option being ignored; Hoyer said it’s been heard

By JAY FRIESS
Staff writer
South Maryland News, SoMdNews.com
Friday, July 3, 2009

Leonardtown psychiatrist Dr. Carol Paris will not be required to complete community service for disrupting a U.S. Senate hearing May 5 on health care reform. So long as she doesn’t break any laws for nine months, the charge could be purged from her record.

Paris said Wednesday that the U.S. attorney originally wanted her to do 40 hours of community service, but dropped the demand Tuesday, since Paris lives more than an hour outside of Washington, D.C.

Five of her fellow protesters must complete community service.

“It’s a total crock,” Paris said of the plea deals. “What those people do for a living is a community service. Their protest was a community service.”

Paris and 12 other advocates of a single-payer health care, sometimes known as “Medicare for all,” were arrested for disorderly conduct after not being given an official opportunity to speak at the hearing conducted by Sen. Max Baucus (D-Mont.). Paris and seven fellow members of Physicians for a National Health Program, a nonprofit advocacy organization, resorted to making statements from the audience without being recognized. Five other members of the organization were arrested at a subsequent hearing May 12.

“I interrupt this so-called public hearing to bring you the following unpaid, political announcement: put single-payer on the table. My name is Dr. Carol Paris, and I approve this message,” Paris proclaimed before she was led away by police and charged with disorderly conduct.

Paris’ protest and subsequent arrest was recorded and uploaded to YouTube.com. Paris said that the national media has ignored the arrests, and added, “Congress doesn’t even know we’ve been arrested.”

Paris said Wednesday that of the 41 people invited to speak at the May hearing, including representatives from insurance and drug industry groups, none addressed nationalizing health care. Paris charged that Baucus purposely banned single-payer advocates from the hearing.

“They represent their lobbied interests; they do not represent their people,” Paris said of the Senate Finance Committee, which is drafting health care reform legislation.

According to Open Secrets, an online database of congressional contributions maintained by the Center for Responsive Politics, Baucus took $3 million in contributions from health care interests in the 2008 election cycle and has already taken $2 million from the same interests in the 2010 cycle. Health interests constitute the second-highest contributing sector for Baucus. The senator’s fifth-highest donor in the last five years has been the health insurance company Blue Cross & Shield.

Paris also scolded Rep. Steny Hoyer (D-Md., 5th), House majority leader, for not pushing debate on a single-payer bill sitting dormant in the House of Representatives. She said that the public deserves to be educated about the issues. “All they know is that Steny Hoyer says that it’s not politically feasible,” Paris said.

Hoyer also counts the health industry as his second-highest donor, taking $910,000 in the 2008 cycle and $82,000 in the current 2010 cycle. The National Association of Retail Druggists has been his fifth-highest contributor in the last five years.

“Congressman Hoyer is committed to listening to the opinions and suggestions of his constituents as he always has,” Hoyer spokeswoman Katie Grant said Thursday in a prepared statement. “He will continue working with both his constituents and his fellow Members of Congress to bring a health care reform bill to the House floor that has broad support and increases access, contains costs, improves quality, and preserves choice of plan and doctor.”

Hoyer’s office said that the House Education and Labor committee held a hearing on the single-payer option. Proponents and experts testified before the Education and Labor; Energy and Commerce; and Ways and Means committees last week.

Paris said she is not looking to be arrested again, but she vowed to continue to advocate for national health insurance. She has drafted a journal article reviewing the corrupting effects of profit motive on health care.

“I have nothing to gain from this,” Paris said. “I will continue to do this, because I want people to be informed. What I see is that people are not informed about the issue.”

Paris said she has received words of encouragement from the community, including a supportive letter from Dr. Chinnadurai Devadason, Charles County’s health officer. She has been invited to give a presentation to the Minority Outreach Coalition on the evening of July 10 at St. Mary’s Church of Christ in California.

jfriess@somdnews.com

http://www.somdnews.com/stories/07032009/entetop155723_32202.shtml

Britain’s National Health Service: Simple, sensible and civilized

A former NHS patient has some advice for Americans skeptical of single-payer, government-run healthcare: You’ll get over it

By Clancy Sigal
Opinion
Los Angeles Times
July 5, 2009

For the first couple of years I lived in Britain, I was an illegal immigrant from the United States, visaless with an expired passport and looking over my shoulder all the time. Even so, from the very first day I arrived at Victoria Station in London, suffering from bronchitis, I was accepted in the NHS — the national health scheme, we called it — no questions asked and no ID required.

After I’d become a legal resident, I asked my doctor why he had taken me, almost literally off the boat, with so little fuss. Weren’t foreigners a drain on his time and the National Health Service? He shrugged. “If you come here with a contagious disease, we don’t want you infecting the rest of us. So of course we give you medical care. Purely selfish on our part.”

For three decades I used and, being of a hypochondriacal nature, exploited the British medical system without paying a farthing except for the taxes taken out of my wages as a working journalist. And that single-payer, socialistic, government-run, bureaucratized, heavily used, nationalized health system served me — and 50 million others — very well. In need, I saw many doctors, with no money ever changing hands. There was nothing to sign, hardly any papers to shuffle. My primary-care physician ran his “surgery,” his office, with the help of only one receptionist whose job it was to arrange appointments.

My doctor’s waiting room in his storefront office was by American standards shockingly casual, even a trifle seedy. In what was then a rigid class society, the waiting room was also a lesson in democracy where duchesses and dustmen, old and young, rich and poor, waited their turn. It wasn’t perfect. There was the occasional misdiagnosis, crowded hospital ward, sleepy student nurse. But it worked.

It was all free, including specialists, and I came to believe that healthcare is a right, not an entitlement I had paid for. This “free” part sometimes puzzled my visiting American friends. When they got ill in London, I’d send them to my doctor, who would smile bemusedly when offered money. Did they appreciate this? Hardly. “Your doctors,” they’d say, “can’t be much good, can they?”

Is this too rosy a picture of single-payer, government-run healthcare? Maybe. Over the years, an underfunded, over-bureaucratized, increasingly privatized NHS has in some areas turned into a shadow of its former vibrant self.

Perhaps I was lucky to arrive so soon after World War II, when a traumatized, bomb-weary public was in no mood to revisit a prewar history of medical deprivation and the humiliation of means testing. Slowly, over time, by argument and debate, a consensus had been achieved, by Conservatives and Labor alike, that, in the words of Edward VIII as Prince of Wales when he first saw the grinding poverty of the unemployed, “something must be done.”

Recently, the American Medical Assn. responded with skepticism to President Obama’s plea for healthcare reform. In Britain, too, the massed ranks of the medical profession at first fought bitterly against a “socialized” service covering all from cradle to the grave. But Labor’s health minister, a firebrand from the mining valleys, Aneurin Bevan, brought them into line with a mixture of enticements and threats.

The NHS was, and is, a classically English compromise, in which individual doctors are independent contractors paid by the government according to the number of their patients. Doctors are free to remove patients from their list, and patients are free to go elsewhere. Once ideology was laid aside and the system got working, it was actually quite simple.

Once launched, in an astonishingly short time, a matter of a year or so, the NHS was accepted by even its worst enemies — the doctors and the Conservative Party — as indispensable and a civilized way of dealing with life, illness and death.

Does that sound so awful?

Clancy Sigal is a writer and former BBC broadcaster who lives in Los Angeles.

NHIS numbers, and building on what works

Town Hall on Health Care

President Obama
The White House
July 1, 2009
Here’s the problem, is that the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers. And so that’s still the way that the vast majority of you get your insurance. And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive. And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system.
We want to build on what works about the system and fix what’s broken about the system.
http://www.whitehouse.gov/the_press_office/Remarks-of-the-President-in-an-Online-Town-Hall-on-Health-Care-Reform/

And…

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2008

by Robin A. Cohen, Ph.D. and Michael E. Martinez, M.P.H., M.H.S.A.
CDC
In 2008, 60.2% of unemployed adults aged 18-64 years and 22.2% of employed adults in this age group had been uninsured for at least part of the past year.
Among persons under age 65 with private health insurance, 17% with employer-based coverage were enrolled in a HDHP, compared with almost 45% of those with a private plan that was directly purchased or obtained through means other than an employer.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200906.pdf

Everywhere you turn those rejecting single payer, including President Obama, say that we want to build on what works and fix what’s broken. They say that what works is our employer-sponsored system of coverage. But does it?
Employer-sponsored plans fail to cover about one-fifth of the workforce. Of those who are covered many have been switched to high-deductible health plans (HDHP), a form of inadequate underinsurance that has been more characteristic of the individual insurance market.
Although the employer-sponsored system falls short for far too many of us, one of the most serious deficiencies is that it is dependent on employment. Well, of course. But that means that three-fifths of the unemployed remain without coverage. And of those insured who do not receive their coverage through their work, 45% have HDHP underinsurance products.
This is really a lousy insurance infrastructure that we are trying to prop up. And nobody in Washington is considering seriously the massive amount of tax subsidies that would be required to help everyone purchase plans with adequate benefits. Establishing an insurance exchange for employers and individuals is of little help if the subsidies won’t fill the gap of affordability. But adequate subsidies are off the table because they are budget busters.
How about dumping what’s broken, and building on a system that works – Medicare.