PNHP

Real life medical debt bankruptcies

Real life medical debt bankruptcies

Bankruptcy filings soared in 2008

By Darrell Smith
The Sacramento Bee
March 17, 2009

Bankruptcy filings in Sacramento and the Central Valley continue to soar as weary residents seek relief from the grip of foreclosures and rising unemployment.

More than 31,000 personal and business bankruptcy petitions were filed in the Eastern District of the U.S. Bankruptcy Court in 2008, an increase of 79 percent over 2007’s filings, according to a report released by the federal court.

The caseload is such that callers to the U.S. Bankruptcy Court in Sacramento are greeted with a message that says clerical staff are too busy to speak with them.

“We have never experienced increases with the number of percent we’re seeing,” said Richard Heltzel, clerk at the U.S. Bankruptcy Court for the Eastern District of California, based in Sacramento.

“With unemployment comes the loss of health insurance – so many of our bankruptcies are triggered by uninsured health care costs,” Heltzel said. “I expect to see close to 40,000 cases this year.”

http://www.sacbee.com/1089/story/1707863.html

Comment:

By Don McCanne, MD

Landmark studies have confirmed beyond any doubt that medical debt is a significant contributor to personal bankruptcy. Yet the opponents of comprehensive reform continue to challenge the data. In the report of John Goodman and his colleagues discussed in yesterday’s message, they stated, “Well-designed economic studies have found no statistical link between bankruptcies and health problems.”

Richard Heltzel, clerk at the U.S. Bankruptcy Court for the Eastern District of California, is not a health policy wonk. His only qualification is that he sees the health care costs listed in the personal bankruptcy filings.

Medical debt is a very real problem, faced by very real people, and it really does contribute to personal bankruptcy. Fortunately, most in Washington seem to understand that now, even if they disagree on what we are going to do about it. We can tell them how this problem can be eliminated, but they are still rejecting our advice, preferring instead to ensure the solvency of the private insurance industry.

Numbers work for single-payer care

By Paul Heise
Lebanon Daily News
03/19/2009

President Barack Obama apparently accepts the conventional wisdom about the failure of the Clinton health-care program: That the very powerful economic and political interests (remember Harry and Louise) that roused the country’s fear of socialism to block Hillary-care will again be able to block a universal, single-payer system. So Obama isn’t even going to try.

Is he right to concede this point? That depends. First, is the public perception of a single-payer system really that bad, and is the cost of wiping out the private insurance companies really economically and politically intolerable? The answers: no, and no.

We know that the Republican message machine is working very hard to label Obama with the dreaded socialist stigma. But the American public is aware how crazy that Republican claim is. Only a couple of months ago the Bush administration nationalized half the banking system without hesitating for a moment. So that ploy is backfiring.

The polls show that message is being seen for what it is, an admission that the right wing has no constructive ideas and is reduced to negative smear tactics at the Rush Limbaugh level.

The Obama administration knows this and is making decisions based on that fact. In the student-loan program, it is quite willing to cut out the private-sector middleman to make that program more efficient despite the whining complaints. The government already guarantees all the loans and would save about $4 billion per year.

Yet we have to admit that the huge savings that could come from eliminating the insurers from the health-care industry would come at the expense of a specific group of people.

That brings us to the fact that changes in government programs, instituted for the common good, often concentrate their impact on specific industries or localities. Sometimes the government compensates, i.e., pays off, the losers, and sometimes it does not. Eminent domain constitutes the most common such compensation.

In 1960, when trade liberalization was being considered, President John Kennedy said: “(T)here is an obligation to render assistance to those who suffer as a result of national trade policy.”

The Trade Adjustment Assistance Program was then instituted and has for years assisted workers, firms and communities that were adversely affected by increased imports. In the present day, the president’s stimulus package, The American Recovery and Reinvestment Act of 2009, expanded the coverage and enhanced the benefits of this program.

Change the word “trade” to “health-care” in Kennedy’s statement, and it is applicable to implementation of a single-payer health-care system.

The medical-insurance carriers administer benefits of approximately $356 billion with 450,000 people and a payroll of $22 billion. Compare that with the Social Security Administration, which administers benefits of $700 billion with 80,000 people and total administrative costs of $10.5 billion.

No harm would come to the medical care of the American people by ending the role of the insurance companies. Most of that payroll cost, and other administrative costs, are employed largely in shuffling claims and determining how to deny benefits, tasks that would disappear under a single-payer system. Virtually everything that the medical insurance carriers do constitutes a make-work project.

The general question of compensating the economic losers, in effect buying them off, is a legitimate economic and moral issue that is not settled. What do we owe people when their lives are affected adversely by government policy? Conversely, we do not expect specific winners to pay the compensation.

The question reaches from simple eminent domain to compensation for false imprisonment to paying off trade or health-care affected firms and workers.

The question does get sticky. When western cattlemen demanded compensation for the loss of subsidized grazing rights on federal land, they were rebuffed because it meant that welfare recipients likewise deserved compensation for lost benefits.

The moral question of whether or not to buy off the medical-insurance carriers and their employees is an unsolved political issue that we can only fight about. The economic question, on the other hand, can be settled rather simply by doing the arithmetic. The example of the rest of the world shows you can get far more medical care for far less money without insurance companies.

Single payer is still the most efficient way even if you pay off the insurance carriers and their employees. And that would be the bold change that Obama promised us.

A resident of Mt. Gretna, Heise holds a Ph.D. in economics and is professor emeritus of economics at Lebanon Valley College. His column appears every other Thursday. He can be reached at his blog:

paulheise.blogspot.com

http://www.ldnews.com/ci_11949767

Why the media blackout on single payer?

Birmingham News
Letter to the Editor
Wednesday, March 18, 2009

It’s amazing that single-payer insurance (national health insurance) is barely covered in the media right now. With President Barack Obama’s focus on both health care and the economic crisis, you’d think information about the most cost-efficient way to design our health care system would be front and center. Add the fact 60 percent of all Americans and 59 percent of physicians favor national health insurance, and you might have to wonder whether private insurance and drug companies are now running the media. We already know they run Congress.

They’ve showered U.S. Sen. Max Baucus, D-Montana, with $413,000 since 2005 in the name of “campaign contributions.” And now, it’s no surprise Baucus is pushing health care reform that mandates Americans buy private insurance.

The truth is, we can save $350 billion annually by removing private insurance companies and going to a single-payer system. And, we wouldn’t be starting from scratch since our Medicare system is already national health insurance for those 65 and older.

Prestigious medical groups, religious organizations, labor unions, economists and others say national health insurance is the way to go. Obama is now asking for input on his new Web site, www.healthreform.gov, before additional health care legislation is written. Submit your ideas and demand national health insurance – as part of the real change you voted for last November.

Linda A. Haynes
Community outreach coordinator
Huntsville chapter of Health Care for Everyone – Alabama
Huntsville

It was wrong to link forum access to cash

Editorial
Des Moines Register
March 19, 2009

The White House selected Iowa as one of only five states to host a regional forum on reforming health care, a top priority for President Barack Obama. On Monday, hundreds of people will gather at the Polk County Convention Center in Des Moines. Such a gathering offers “an opportunity for Americans from all over the country to voice their concerns and ideas about reforming our health-care system,” according to the White House’s health-reform Web site.

Iowa had a different plan, offering tickets and recognition to those willing to pay thousands of dollars to be a sponsor. Up until yesterday anyway – when the Register started asking questions. The episode offers a peek at the cozy relationship between government and powerbrokers – and how that typically ensures the powerful will get their seat at the table, while ordinary Americans may get sidelined.

Last week, Gov. Chet Culver’s office announced that tickets were to be distributed by a lottery. Tickets were expected to be hard to come by, and some health-care advocates voiced concerns that they wouldn’t get to attend. With the sponsorship plan, that wasn’t going to be a worry for those forking over big bucks.

In an e-mail obtained by the Register, Kate Walton, Culver’s top health-care adviser, offered a “sponsorship opportunity” to recipients including AARP, the Federation of Iowa Insurers and the Iowa Hospital Association to “help defray the cost of the event.”

“We are hoping sponsors could participate at the $5,000 level, but are certainly open to discussion if that amount is in excess of what you are able to do, but you would still like to be included as a sponsor. Event sponsors will be visibly acknowledged at the event, so we would appreciate you sharing your organization’s logo if you choose to participate,” according to the e-mail.

The message: Pay up and you can have a space at the table and special recognition at the event. If you can’t pay $5,000, maybe we can negotiate.

Phil Roeder, Culver’s communications director, told the Register the White House had said the governor’s office could use sponsorships to defray expenses. But when initially contacted Wednesday morning, a White House spokeswoman said she didn’t know about the plan. By noon, she had released a brief statement that there would be “no outside sponsorship of the event.”

It’s no secret wealthy and powerful special interests dominate health-care discussions in this country. But the governor’s office essentially extended an invitation for them to do so – and to send their logo for a little extra publicity. Iowa Health System, the state’s largest hospital system, told the Register it had paid the state $5,000 to be a sponsor.

Now Iowa Health and any other takers will be getting refunds. And any tickets that had been reserved for donors should be distributed through the lottery.

It shouldn’t take the White House – or the newspaper – to point out what a bad idea this was. Essentially selling tickets and recognition for such a forum undermines the very intent of the gathering. Obama has said he wants everyone bringing ideas – not just those who can afford to buy a seat.

Additional Facts

A reminder about ethics

The e-mail from state government asking for donations in exchange for tickets and recognition also included an attachment.

It begins: “The Iowa White House Forum on Health Reform is made possible by generous donations from people like you. It is especially important for individuals and corporations to show their commitment to health-care reform through a monetary gift.”

What?

Donations from “people like you” (aka those who can give thousands of dollars) didn’t make the forum possible. President Barack Obama did, by saying the forums would be conducted. Monday’s gathering was going to happen with or without such donations.

The rest of the attachment reminded recipients that state law requires public disclosure of such donations to an ethics and campaign disclosure board.

Perhaps some staffers in state government need a refresher course in the ethic that money shouldn’t buy special access to public-policy discussions.

John Goodman hides the rest of the story

The U.S. Health System: The Rest Of The Story

By John Goodman
Health Affairs Blog
March 19, 2009
Here is a paper (link below) with as many as 100 references that you almost never see cited in Health Affairs, or in the Journal of the American Medical Association (JAMA), or in the New England Journal of Medicine (at least not in their public policy articles). In fact, if you are a regular reader of these publications, I think you are going to be very surprised.
My colleagues Linda Gorman, Devon Herrick, Robert Sade and I discovered that public policy articles in the leading health journals (especially the health policy journals) tend to cite poorly done studies over and over again in support of two propositions: (1) Our health care system needs radical reform and (2) the reform needs to be modeled along the lines of the systems of other developed countries. At the same time, these articles tend to ignore contravening studies that are often published in economics journals and subject to much more rigorous peer review.
In our rest-of-the-story literature review, we focus on eight questions:
1. Does the United States spend too much on health care?
2. Are U.S. outcomes no better and in some respects worse than those of other nations?
3. Is the large number of uninsured in the U.S. a crisis?
4. Does lack of health insurance cause premature death?
5. Are medical bills causing bankruptcy?
6. Are administrative costs higher for private insurance than public insurance?
7. Are low-income families more disadvantaged in the U.S. system?
8. Can the free market work in health care?

John Goodman says that he wants us to hear the rest of the story, but then he doesn’t tell it to us.
He and his colleagues have pieced together a document using classic Goodman rhetorical deceptions. They pull out of the literature isolated items that support their position without identifying them as exceptions to the great body of information available in the health policy literature. They repeat the use of many studies that have been discredited as manipulations or distortions based on libertarian ideology, even though they are aware of the highly credible challenges to those reports. They use silly diversions to attack some of the most solid and important studies in the health policy literature. Patching these deceptions together creates magical conclusions that would seem to refute the most fundamental principles that can be gleaned from a couple of decades of solid health policy science research.
Using health policy reports retrieved from the refuse bin, they then end with the conclusion that we should adopt their favored proposal for reform, health savings accounts, a non sequitur to the specious arguments they have presented. Even though the policy community has dismissed HSAs as a serious response to the tragic dysfunction of our health care system and its financing mechanisms, the authors persist in abandoning their academic purity in pushing their cause.
“The Rest of the Story” might appeal to ideologues, but it is repulsive to those of us who are outraged by the the physical suffering and financial hardship faced by the millions of U.S. residents who are victims of a flawed financing system, unable to afford or receive the care that they need in a $2.5 trillion health care industry.
http://healthaffairs.org/blog/2009/03/19/the-us-health-system-the-rest-of-the-story/comment-page-1/#comment-24954
Paper on health care reform by John Goodman et al:
http://www.ncpa.org/pdfs/sp_Do_Other_Countries_Have_the_Answers.pdf

John Goodman hides the rest of the story

The U.S. Health System: The Rest Of The Story

By John Goodman
Health Affairs Blog
March 19, 2009

Here is a paper (link below) with as many as 100 references that you almost never see cited in Health Affairs, or in the Journal of the American Medical Association (JAMA), or in the New England Journal of Medicine (at least not in their public policy articles). In fact, if you are a regular reader of these publications, I think you are going to be very surprised.

My colleagues Linda Gorman, Devon Herrick, Robert Sade and I discovered that public policy articles in the leading health journals (especially the health policy journals) tend to cite poorly done studies over and over again in support of two propositions: (1) Our health care system needs radical reform and (2) the reform needs to be modeled along the lines of the systems of other developed countries. At the same time, these articles tend to ignore contravening studies that are often published in economics journals and subject to much more rigorous peer review.

In our rest-of-the-story literature review, we focus on eight questions:

1. Does the United States spend too much on health care?

2. Are U.S. outcomes no better and in some respects worse than those of other nations?

3. Is the large number of uninsured in the U.S. a crisis?

4. Does lack of health insurance cause premature death?

5. Are medical bills causing bankruptcy?

6. Are administrative costs higher for private insurance than public insurance?

7. Are low-income families more disadvantaged in the U.S. system?

8. Can the free market work in health care?

****

Response to “The U.S. Health System: The Rest Of The Story”

By Don McCanne

John Goodman says that he wants us to hear the rest of the story, but then he doesn’t tell it to us.

He and his colleagues have pieced together a document using classic Goodman rhetorical deceptions. They pull out of the literature isolated items that support their position without identifying them as exceptions to the great body of information available in the health policy literature. They repeat the use of many studies that have been discredited as manipulations or distortions based on libertarian ideology, even though they are aware of the highly credible challenges to those reports. They use silly diversions to attack some of the most solid and important studies in the health policy literature. Patching these deceptions together creates magical conclusions that would seem to refute the most fundamental principles that can be gleaned from a couple of decades of solid health policy science research.

Using health policy reports retrieved from the refuse bin, they then end with the conclusion that we should adopt their favored proposal for reform, health savings accounts, a non sequitur to the specious arguments they have presented. Even though the policy community has dismissed HSAs as a serious response to the tragic dysfunction of our health care system and its financing mechanisms, the authors persist in abandoning their academic purity in pushing their cause.

“The Rest of the Story” might appeal to ideologues, but it is repulsive to those of us who are outraged by the the physical suffering and financial hardship faced by the millions of U.S. residents who are victims of a flawed financing system, unable to afford or receive the care that they need in a $2.5 trillion health care industry.

http://healthaffairs.org/blog/2009/03/19/the-us-health-system-the-rest-of-the-story/comment-page-1/#comment-24954

Paper on health care reform by John Goodman et al:
http://www.ncpa.org/pdfs/sp_Do_Other_Countries_Have_the_Answers.pdf

Time to think big on health care

Editorial
Brattleboro Reformer
Tuesday, March 17

Today in Burlington, Massachusetts Gov. Deval Patrick and Vermont Gov. James Douglas will co-host the second of five regional health care forums sponsored by the Obama administration.

It’s only a 90-minute event, and it seems more for show than actual discussion and the gathering of information. Still, health care reform advocates believe this event is important, since Vermont, Massachusetts and Maine are seen as national leaders in this area.

Vermont’s accomplishments in health care are considerable. Catamount Health, while imperfect, showed how to subsidize private health insurance and expand coverage to the uninsured. The state is working on an electronic network for medical information. Its chronic care initiative is a significant step forward in reducing costs. The Blueprint for Health has helped to shift focus to prevention and healthy living rather than treating conditions after the fact.

All this is well and good, but even if these programs were adopted nationally, it would be just nibbling around the edges of a huge problem.

There remains 46 million uninsured and 25 million underinsured Americans. Health insurance is tied to one’s employment, and because of the rising unemployment rate, about 14,000 Americans are losing their coverage daily.

Many Americans are one illness away from financial ruin. Every 30 seconds, someone in the United States files for bankruptcy because of medical bills.

An estimated 18,000 Americans die each year for lack of health insurance.

The United States has the most expensive health care system per capita of any nation in the world, yet we lag behind many developed countries in virtually every health category from infant mortality to life expectancy.

No, nibbling around the edges won’t deal with the threat that more and more Americans face — that they will go broke or die because they haven’t got health insurance. And the one plan that can solve this problem, some model of a single-payer system — where the government collects taxes to finance national health insurance that covers every citizen and pays the bills for medical care — is not being seriously discussed by anyone in the Obama administration.

Oliver Fein, president of Physicians for a National Health Program, has said that a single-payer program would offer $400 billion in annual administrative savings and would bring “effective cost containment provisions such as bulk purchasing and global budgeting.”

The single payer-system delivers big cost savings because there is only one insurer — the federal government — negotiating bulk purchases of drugs, setting fees with health care providers and drafting global budgets for hospitals and large clinics. Doing this eliminates the profits of private insurers, the drug companies and for-profit health care providers — the biggest drivers of health care costs.

While the cost would be publicly financed, the care would still be privately delivered. Every hospital and doctor would be available to everyone, without the worries about whether your provider is in your current private insurance plan. There would be no “cherry picking” of healthy people or rejection of the chronically ill.

This is the system used by nearly every other industrialized nation in the world. This is the system that the private health insurance industry, the drug companies and every other entity that benefits from the current system fears — for it means the end of their gravy train of profits. That is why every attempt at overhauling our nation’s health care system has met with vehement opposition by these forces.

If today’s forum is to have any value beyond public relations, it will come if Vermonters deliver this message to President Obama: If he is serious about health care reform, single-payer has to be part of the discussion.

President Obama has already said that he is not afraid of taking on the lobbyists and political action groups. Let him prove it to Americans. There is no lobby more entrenched than the medical-industrial complex, which killed the tepid attempts at reform by the Clinton administration in 1994.

We want to see the president stand up to the forces that have created a system that is wasteful and inefficient and turned medicine into a for-profit commodity. We want him to state, without equivocation, that health care is a human right and that every American must have access to quality, effective and timely health care. We want him to support real reform, and not just nibble around the edges. That real reform is single-payer health care.

http://www.reformer.com/ci_11930733

Single-payer supporters to rally at March 23 health forum in Des Moines, Iowa

FOR IMMEDIATE RELEASE
March 19, 2009

Contacts:
Ronald Lind, M.D.
Jess Fiedorowicz, M.D.,
Lisa Nilles, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

MEDIA ADVISORY

Physicians, nurses and health reform advocates to urge enactment of ‘an improved Medicare for All,’ decry outsized influence of corporate medicine at regional meeting

What

Press conference and rally to express support for single-payer national health insurance and to protest the “marginalization of majority opinion” at Monday’s White House Forum on Health Care Reform at the Polk County Convention Complex in Des Moines, Iowa, at 9 a.m. CDT.

The forum will be hosted by Iowa Gov. Chet Culver. Nancy-Ann DeParle, the director of the White House Office of Health Care Reform, will represent the Obama-Biden administration. U.S. Senators Chuck Grassley and Tom Harkin are also expected to attend.

Spokespersons for Physicians for a National Health Program (PNHP) and other advocates of single-payer national health insurance, sometimes called an improved Medicare for All, will urge that single payer be “on the table” as a full-fledged option and will decry the outsized role of the private health insurance industry, Big Pharma, and other representatives of corporate medicine at the White House-sponsored forum, one of five that are being across the country.

Geri Jenkins, president of the National Nurses Organizing Committee (NNOC), will also speak at the press conference and rally.

Physicians wearing their white coats and RNs in their scrubs, along with other health reform advocates, will assert that national health insurance is being accorded a minor, marginalized role at the forum, even though surveys show two-thirds of Americans and 59 percent of U.S. physicians support it.

Rally participants will demand that the single-payer model be given pride of place in the health care debate, given that model’s proven effectiveness in providing universal, comprehensive care; its ability to contain costs; and the fact that its annual savings in administrative costs — $400 billion — will mean that it will require no increase in U.S. health spending.

Who

Ronald Lind, M.D., an anesthesiologist in St. Charles, Iowa.
Jess G. Fiedorowicz, M.D., a psychiatrist and clinician investigator at the University of Iowa.
Lisa Nilles, a pediatrician and chaplain in Minneapolis, Minn.
Geri Jenkins, RN, president, National Nurses Organizing Committee.
Leslie Heemsbergen, RN, 27-year Iowa nurse.
Other health professionals and representatives of organized labor.

When

9 a.m. CDT, Monday, March 23

Where

Polk County Convention Complex, 5th Ave. and Grand Ave., downtown Des Moines, immediately outside main entrance.

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

Tenet paid overtime hours by math, not money

O.C. hospital owner to pay $85M to settle OT dispute

By Courtney Perkes
The Orange County Register
March 11, 2009
Tenet Healthcare, the owner of three Orange County hospitals, has agreed to pay $85 million to settle claims that nurses and other 12-hour-shift employees were denied extra pay after a change in California law entitled them to overtime.
At the time the law changed, Tenet was the county’s largest hospital owner with 10 facilities. In settling, the Texas-based company admitted no wrongdoing, but spokesman David Matthews said the California pay practice has stopped.
The case centered on Tenet’s “California differential” pay scale, according to court documents. The suit alleged that to avoid overtime costs, Tenet lowered the hourly pay rate for employees when they worked more than eight hours a day. That meant that while technically earning overtime, their net wages remained the same as before.
According to the suit, Tenet used as many as five hourly pay rates depending on the length of the work shift.
“It’s not enough for an employer to demonstrate that it pays overtime on paper,” said Frank Coughlin, a Santa Ana attorney representing Pagaduan. “They have to pay overtime in money, not math.”
http://www.ocregister.com/articles/tenet-overtime-pay-2332101-pagaduan-settlement

Although PNHP is most noted for its advocacy of a single payer national health program, we also oppose the perversities of for-profit health care corporations in which the primary responsibility of the board of directors is to their investors. Tenet Healthcare has provided us with innumerable examples of these perversities. A quick Google of the PNHP website, in a fraction of a second, produced these lines and many more:
“For-profit hospital chain Tenet, formerly National Medical Enterprises (NME), is the subject of four separate federal investigations…”
“Troubled Tenet Healthcare dominates the expensive list…”
“Overall Tenet’s hospitals averaged gross markups of 477% over costs…”
“Last week, the hospital’s owner, Tenet Healthcare, agreed to pay $54 million to the government to resolve accusations that Redding Medical doctors conducted unnecessary heart procedures and operations on hundreds of healthy patients…”
“Tenet, the second largest US hospital firm, paid more than half a billion dollars to settle…”
“Tenet’s CEO exercised stock options worth $111 million…”
“OrNda Healthcorp, a hospital chain recently acquired by Tenet, paid fines of $12.65 million to the government for kickbacks to physicians for referrals…”
And this was only the first page Googled, but you get the gist.
Regardless of the wisdom of the California requirement of paying 4 hours of overtime for a 12 hour shift, it is the law, and there are several options that Tenet had to comply with it. As a for-profit corporation, they chose a method that would protect their investors from higher labor costs, but a method that involved dishonest accounting.
The employees no longer knew what their hourly wages were because, for each paycheck, Tenet retroactively calculated the hourly wage base so that it would wipe out overtime payments, and that base wage would vary from paycheck to paycheck.
Would you feel secure in a Tenet hospital? What other ways are they cheating to improve their bottom line?
HR 676, the United States National Health Care Act or the Expanded and Improved Medicare for All Act introduced by Rep. John Conyers, would provide for comprehensive health insurance coverage for all United States residents, but that is not all. Recognizing the conflicted interests of for-profit corporations in health care, HR 676 also includes the provision that for-profit providers of care opting to participate shall be required to convert to not-for-profit status.
HR 676 was introduced only seven weeks ago, and already has 66 cosponsors, far more than any other health reform legislation. Yet the members of the House and Senate who are leading the reform process have refused to include it in the dialogue on reform, insisting that any reform include not only the perversities of the for-profit health care corporations, but also, even worse, the profound waste and injustices of a financing system patched together with private health plans.
(The remainder of this message has been deleted because it contained expletives, or would have had it been written.)

Tenet paid overtime hours by math, not money

O.C. hospital owner to pay $85M to settle OT dispute

By Courtney Perkes
The Orange County Register
March 11, 2009

Tenet Healthcare, the owner of three Orange County hospitals, has agreed to pay $85 million to settle claims that nurses and other 12-hour-shift employees were denied extra pay after a change in California law entitled them to overtime.

At the time the law changed, Tenet was the county’s largest hospital owner with 10 facilities. In settling, the Texas-based company admitted no wrongdoing, but spokesman David Matthews said the California pay practice has stopped.

The case centered on Tenet’s “California differential” pay scale, according to court documents. The suit alleged that to avoid overtime costs, Tenet lowered the hourly pay rate for employees when they worked more than eight hours a day. That meant that while technically earning overtime, their net wages remained the same as before.

According to the suit, Tenet used as many as five hourly pay rates depending on the length of the work shift.

“It’s not enough for an employer to demonstrate that it pays overtime on paper,” said Frank Coughlin, a Santa Ana attorney representing Pagaduan. “They have to pay overtime in money, not math.”

http://www.ocregister.com/articles/tenet-overtime-pay-2332101-pagaduan-settlement

Comment:

By Don McCanne, MD

Although PNHP is most noted for its advocacy of a single payer national health program, we also oppose the perversities of for-profit health care corporations in which the primary responsibility of the board of directors is to their investors. Tenet Healthcare has provided us with innumerable examples of these perversities. A quick Google of the PNHP website, in a fraction of a second, produced these lines and many more:

“For-profit hospital chain Tenet, formerly National Medical Enterprises (NME), is the subject of four separate federal investigations…”

“Troubled Tenet Healthcare dominates the expensive list…”

“Overall Tenet’s hospitals averaged gross markups of 477% over costs…”

“Last week, the hospital’s owner, Tenet Healthcare, agreed to pay $54 million to the government to resolve accusations that Redding Medical doctors conducted unnecessary heart procedures and operations on hundreds of healthy patients…”

“Tenet, the second largest US hospital firm, paid more than half a billion dollars to settle…”

“Tenet’s CEO exercised stock options worth $111 million…”

“OrNda Healthcorp, a hospital chain recently acquired by Tenet, paid fines of $12.65 million to the government for kickbacks to physicians for referrals…”

And this was only the first page Googled, but you get the gist.

Regardless of the wisdom of the California requirement of paying 4 hours of overtime for a 12 hour shift, it is the law, and there are several options that Tenet had to comply with it. As a for-profit corporation, they chose a method that would protect their investors from higher labor costs, but a method that involved dishonest accounting.

The employees no longer knew what their hourly wages were because, for each paycheck, Tenet retroactively calculated the hourly wage base so that it would wipe out overtime payments, and that base wage would vary from paycheck to paycheck.

Would you feel secure in a Tenet hospital? What other ways are they cheating to improve their bottom line?

HR 676, the United States National Health Care Act or the Expanded and Improved Medicare for All Act introduced by Rep. John Conyers, would provide for comprehensive health insurance coverage for all United States residents, but that is not all. Recognizing the conflicted interests of for-profit corporations in health care, HR 676 also includes the provision that for-profit providers of care opting to participate shall be required to convert to not-for-profit status.

HR 676 was introduced only seven weeks ago, and already has 66 cosponsors, far more than any other health reform legislation. Yet the members of the House and Senate who are leading the reform process have refused to include it in the dialogue on reform, insisting that any reform include not only the perversities of the for-profit health care corporations, but also, even worse, the profound waste and injustices of a financing system patched together with private health plans.

(The remainder of this message has been deleted because it contained expletives, or would have had it been written.)

The real health care lessons from Europe

By Irfan Dhalla and Chris Mackie
Ottawa Citizen
March 17, 2009

In Belgium, there are four doctors for every 1,000 residents compared to 2.1 per 1,000 in Canada.

In the United Kingdom, the government has established an independent agency to evaluate new technologies before paying for expensive treatments that do not provide significant benefit.

In Denmark, local governments play a role in deciding where family doctors will establish their practices and more than 80 per cent of health care is paid for publicly, compared with about 70 per cent in Canada.

Yet instead of returning from his recent European sojourn trumpeting these facts and all the ways we might innovate within medicare, Canadian Medical Association president Dr. Robert Ouellet has decided that what makes health care work in Europe is that they make better use of the private sector (as favourably reported in the Citizen editorial “Medical improvement,” March 7).

If our goal is merely to convince Canadians that privatization can improve health care, selectively citing some European examples is a pretty good strategy.

But if we truly want to bring the lessons of European health care to Canada, we should realize that privatization has never been the European prescription.

In fact, in almost all European countries, privatization has played only a cameo role.

Some of the lessons of Europe can already be found in Canada.

Across our own country, small-scale solutions are being implemented that are making our system safer, more effective, and more efficient.

Electronic prescribing, integrated home care, centralized waiting lists, better health technology assessment, and increased team-based care are just a few.

But instead of suggesting how we might improve medicare, Dr. Ouellet argues not only for increased private funding, which would mean user fees and a greater role for private insurance companies, but also for increased private delivery within the publicly funded system.

If he examined the evidence, including that produced by the organization he leads, Dr. Ouellet would know that the debates about user fees and private insurance are essentially dead.

Economists have repeatedly demonstrated that user fees reduce health care consumption and short-term costs. But the same research also shows that user fees reduce both necessary and unnecessary health care. Patients often don’t know whether they need to see a doctor or not.

Ignoring a nagging cough that’s been hanging on for a week is unlikely to cause harm. But ignoring a painless lump under the armpit might delay a diagnosis of cancer.

So we should continue to encourage people to seek care early by keeping doctor visits free.

Similarly, private insurance has repeatedly been demonstrated to be both inefficient and unfair. Insurance companies don’t want to insure people who are likely to need health care. Even when they do provide insurance, they use every tool at their disposal to avoid paying out on claims.

Using the private sector to provide publicly funded health care admittedly has some intuitive appeal. At least it used to back in the good old days when we all believed in the supremacy of the market.

But if the economic crisis has taught us anything it should be that we need to be wary of those who answer “privatization” regardless of the question.

Market-based competition in health care might look good on paper, but it doesn’t always work in practice. Many towns need only a single hospital, which makes competition impossible. And even in urban areas, hospitals that are forced to compete rather than co-operate tend to end up fighting over the least complicated and most profitable patients, leaving fewer options for those with complex illnesses who are in greatest need of care.

We should all be wary of selective comparisons to European countries that are devoid of context.

Most European countries are geographically tiny, which makes their health care systems easier to organize. Their social safety nets are more tightly woven, income taxes are higher, and health care professionals are usually paid significantly less — in part because they cannot easily emigrate to the United States.

Is Dr. Ouellet arguing for higher income taxes and lower pay for Canadian doctors?

Although there is much to learn from Europe, and even from the United States, we have a long list of worthwhile innovations right here in Canada that we know will improve our health care system if they are implemented more widely.

What ordinary doctors and Canadians want to see is a movement for change in health care that draws on those aspects of European systems that are based on evidence and consistent with our values.

Dr. Irfan Dhalla is a general internist at St. Michael’s Hospital in Toronto. Dr. Chris Mackie is a public health physician in Hamilton. Both sit on the board of Canadian Doctors for Medicare.

(c) Copyright The Ottawa Citizen

Single-payer health care system touted

150 rally in support of concept at regional forum at UVM

By Nancy Remsen
Burlington Free Press
March 18, 2009

Dr. John Walsh, a neuroscience researcher from Worcester, Mass., stood Tuesday with 150 other sign-carrying supporters of government-financed health care outside the building where 400 invited guests would attend a regional health care reform forum sponsored by the Obama White House. Walsh passed out yellow fliers that denounced President Barack Obama for failing to live up to promises to consider a Canadian-style health insurance system. “Single payer is the choice in the polls,” Walsh declared.

Sandy Eaton of Quincy, Mass., and a member of the Massachusetts Nurses Association, came to the only forum scheduled for the Northeast to add his voice to those demanding that national policymakers weigh the merits of a government-financed system when they discuss reform options. “Let’s make sure there is a fair and legitimate comparison,” Eaton said.

Rebecca Elgie, a retired teacher, traveled six hours from Ithaca, N.Y., because she has made advocacy for a single-payer system her cause. Three years ago she walked 400 miles across her state to raise awareness about the need for a better way to pay for health care. Elgie said, “The employee-based system has outlived its usefulness.”

The rally greeted the invited guests as they strolled toward the Davis Center at the University of Vermont under a bright blue sky. “They need to know there is enough support for people to drop everything and come here to support single payer,” said Dr. Deb Richter, a Montpelier family physician and prime force in the single-payer movement in Vermont.

“Barack Obama is with us,” Richter told the rally participants. “President Obama is in a leaky boat out there in an ocean surrounded by sharks. We can’t expect President Obama to stick his toe in the water. He needs our help. That is why we are here today.”

Many at the rally were sure single-payer advocates would be ignored during the forum, even though some, including Richter, had tickets. But Gov. Deval Patrick of Massachusetts, who co-hosted the forum with Gov. Jim Douglas of Vermont, didn’t duck the topic. He put a spotlight on it.

“Is there one way?” Patrick asked the audience. “Should we have a couple of different ways or should we have a national template? Let’s talk a little about single payer.”

Richard Slusky, chief executive at Mount Ascutney Hospital in Windsor, described himself as a single-payer advocate, but added, “It doesn’t have to be an absolute, government-run system. We can have a system that involves the private sector.”

Susan Baker of the Vermont Public Interest Research Group said, “People want choice.” She said a publicly financed health insurance option should be available to anyone, not just those with low income.

Patrick called on Richter, who sat in a front row in her white coat. Noting the administrative burden that physicians face dealing with dozens of health insurance payers, Richter asked, “Why would we even need private insurance?”

Jim Hughes, a retired physician from West Fairlee, observed the sky didn’t fall when Patrick, a politician, dared to say the words “single payer.”

“We ought to talk about it,” Patrick said.

Nancy-Ann DeParle, director of the White House Office of Health Reform, offered a cautionary note about a single-payer system. She asked how many in the audience had health insurance, and then asked, “How many people would want to change what they have? That is one thing we have to keep in mind.”

Later at a news conference, Douglas replied to a question about the prospects of the single-payer concept with a warning about the politics of the issue. “There are lots of different ideas. We can move in a significant way without moving so dramatically that it is difficult to gain consensus.”

Other speakers posed questions for policymakers to consider as they fashion a new health system.

“What will you do for the next generation?” asked Bronwyn Fleming-Jones, a University of Vermont senior worried about how she will pay for health insurance after she graduates in two months.

Will reform consider the importance of home health care? asked Gary Sheehan, president of Cape Medical Supply.

Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center, urged policymakers to “focus on people, not patients and think beyond the silo of the health care budget.”

DeParle and the two governors will report to Obama about the forum. Three more forums are scheduled in other areas of the country. DeParle said she was learning information about programs that work, ideas that should be tried and political strategy to win support for change.

“You have two governors here who figured out how to get that support,” DeParle said.

“It took a very broad coalition to come together to design health care reform in Massachusetts and they have stayed together,” Patrick said. He added, it also took a realization “that there were other choices than the two choices on the table — the perfect solution and no solution at all.”

Contact Nancy Remsen at 578-5685 or nremsen@bfp.burlingtonfreepress.com.

http://www.burlingtonfreepress.com/article/20090318/NEWS03/90318001

Link to many photos:
http://www.burlingtonfreepress.com/apps/pbcs.dll/gallery?Avis=BT&Dato=20090317&Kategori=NEWS&Lopenr=903170803&Ref=PH