PNHP

Families USA report on COBRA

Families USA report on COBRA

Squeezed! Caught between Unemployment Benefits And Health Care Costs

Families USA
January 2009

By November 2008, more than 2.7 million people had joined the ranks of the unemployed since the recession began in 2007, and 10.3 million people were unemployed. Many of those people (and their families) lost their health coverage when they lost their jobs.

Some workers who had insurance through their former employers may be able to continue to purchase the same coverage — but they must pay the full cost out of their own pockets. This continuation coverage, called “COBRA” (from the Consolidated Omnibus Budget Reconciliation Act of 1986), could provide a vital health care lifeline for many families. Unfortunately, for most individuals and families, the cost of this coverage is prohibitively high, especially when compared to average unemployment benefits.

$1278 – Average monthly unemployment income

$388 – Average COBRA premium for an individual
30% – Premium as a share of unemployment income

$1069 – Average COBRA premium for a family
83% – Premium as a share of unemployment income

Conclusion

As our nation faces a severe recession, growing numbers of unemployed workers and their families are coping with the loss of health insurance. The short- and long-term physical and financial consequences of such a loss can be devastating. COBRA continuation coverage can be a crucial health lifeline for newly unemployed workers. But while many workers have the right to purchase such coverage, the cost is often prohibitively high. To make COBRA coverage truly affordable, a meaningful subsidy should be provided to recently unemployed workers. For those who do not have a COBRA coverage option, Congress should provide a temporary Medicaid benefit to recently unemployed, low-wage workers.

http://www.familiesusa.org/assets/pdfs/cobra-2009.pdf

Comment:

By Don McCanne, MD

Families USA has continued to be a source of highly credible studies demonstrating the severe deficiencies in health care financing in the United States. A prime example is this study of COBRA benefits. Although the intent of COBRA was to allow individuals and families to maintain their employer-sponsored coverage after losing their jobs, this study demonstrates that this is yet another failed policy as unemployed individuals are unable to pay for that coverage.

Unfortunately, the conclusion of this study also represents yet another inadequate policy recommendation of Families USA. The obvious conclusion is that health insurance must be automatic, for life, and comprehensive enough to prevent financial hardship regardless of income or health status. Instead, Families USA would leave this flawed COBRA program in place, and merely tweak it so that a few of the 46 million uninsured could receive coverage. Temporary Medicaid? Come on!

It is no secret that PNHP and Families USA have had their differences. The leadership of PNHP has demonstrated that a single payer national health program would provide affordable health care for everyone throughout life. The leadership of Families USA has continued to insist that single payer is not feasible, and that reform must occur in incremental steps – increments such as subsidies for COBRA benefits.

We have been following for decades their preferred course of incremental reform, and all parameters are worse. We have an outrageously expensive system with increasing numbers of uninsured and underinsured, and ever greater financial hardship for those individuals and families with health care needs. Of nineteen industrialized nations, we have the worst rate of amenable mortality (premature deaths which are preventable). Incrementalism has been a cruel, miserable policy failure in the United States.

The leadership of Families USA understands this. Thus for the past decade they have supported “strange bedfellow” coalitions, bringing together organizations that traditionally have been at odds on the reform issues. Each of these efforts has been introduced with considerable fanfare, with the obligatory statements from each participating organization to the effect that finally we are coming together to fix our health care system.

What happens? Behind the scene the opponents of reform continue to sabotage the efforts. The opponents are using the reputation of Families USA to burnish their own tarnished images, while gaining additional years before they must face the inevitability of a bona fide national health program.

The opponents will never support a program that is contrary to their selfish interests or their right-wing ideology. NEVER!

For those who believe that we are close to bringing all interests together on reform, think about this. The leading reform proposal is based on private health plans which everyone knows are no longer affordable, and the Republicans will never approve an adequate “tax on the rich” that would be needed to pay for those plans. The supporters also have recommended the creation of a public insurance option which individuals could purchase (even though it wouldn’t be affordable either). Yet the opponents have blasted the proposal because it is an incremental step towards single payer. AHIP, USCOC and some of the Senate Republicans have made it clear that this is a non-starter.

Forget incrmentalism! Forget sleeping with the enemy!

Ronny, sorry, but what you’ve been doing just hasn’t worked. It’s time for you to get up out of that bed and join us in our crusade for the real thing – health care justice for all.

****

Note of Clarification: What is the fundamental disagreement? One side wants an affordable, high-quality health care system that really does include everyone. The other side is opposed, either because of anti-egalitarian ideology or simply because of selfish self-interest. That is where the battle must take place.

The debate over an incremental versus comprehensive strategy for reform has been an unfortunate digression that has splintered one side – the supporters of health care justice. PNHP, Families USA, UHCAN, Healthcare-NOW!, Health Care for All, the HCAN coalition, and all of the other individuals and organizations that share the common goal of health care for everyone must unify in support of truly comprehensive reform that does not compromise on the policies that will get us there. This goal must have precedence above all others and must represent the primary thrust of our efforts.

That does not mean that there is no place for incremental measures. The Children’s Health Insurance Program (SCHIP) is an incremental measure that must be renewed and expanded immediately, but only as an urgent, temporary measure until we can enact a comprehensive program for everyone, including children.

It is absolutely crucial that we all pull together now, pulling out all the stops, especially while we are in this political window. Once we have a comprehensive system, the incrementalists can have a field day tweaking the inevitable glitches in the system.

How to Push Obama

By John Nichols
The Progressive
Jan. 5, 2009

On November 4, the American people by a popular majority of more than eight million votes selected as their new President a Democratic contender who had been attacked by his Republican foe as a radical who “began his campaign in the liberal left lane of politics and has never left it.”

If only. In truth, Barack Obama was never the Che Guevara in pinstripes that the rightwing attack machine conjured up. His record on Capitol Hill was never “more liberal than a Senator who calls himself a socialist [Vermont’s Bernie Sanders],” as John McCain wheezed at the last stops of a dying campaign. And he has never even been in competition for the title bestowed upon him by former Senator Fred Thompson during last summer’s Republican National Convention: “the most liberal . . . nominee to ever run for President.”

Thompson had apparently forgotten not just George McGovern but Walter Mondale and Michael Dukakis, all of whom sought the Presidency as more left-leaning contenders than did Obama in 2008. And, as McGovern, an able historian, himself reminds us: Franklin Roosevelt put contemporary Democrats to shame when it came to embracing and advancing radical notions.

For today’s liberals and progressives, who find themselves moving from the comfortably predictable opposition stance of the Bush-Cheney interregnum to the more challenging position of dealing with the first Democratic President elected with something akin to a mandate since Lyndon Johnson in 1964, it is important to see Barack Obama for who he is and his administration for what it can be. The best way to do this is not by listening to Obama’s Republican detractors–or to the lite-Republicans of the Washington Democratic establishment–but by hearing the President- elect in his own words.

After he secured the delegates required to claim the Democratic nomination, Obama found himself at a town hall meeting in suburban Atlanta, where he was grilled about whether–having run as a primary-season progressive–he was now shifting to the center.

The Senator was clearly offended by the suggestion. “Let me talk about the broader issue, this whole notion that I am shifting to the center or that I’m flip-flopping or this or that or the other,” he began. “You know, the people who say this apparently haven’t been listening to me.”

Obama continued: “I am somebody who is no doubt progressive. I believe in a tax code that we need to make more fair. I believe in universal health care. I believe in making college affordable. I believe in paying our teachers more money. I believe in early childhood education. I believe in a whole lot of things that make me progressive.”

Those were not casually chosen words. Barack Obama knows exactly what it means to say he is a “progressive.” When he does so, he is not merely avoiding the word “liberal,” as the sillier of his rightwing critics like to claim. Obama actually understands the subtle nuances of the American left. This is a man who moved to Chicago to be part of the political moment that began with the 1983 election of leftie Congressman Harold Washington as the city’s first African American mayor, who studied the organizing techniques of Saul “Rules for Radicals” Alinsky, who worked with proudly radical labor leaders to defend basic industries and avert layoffs, who used his Harvard-minted legal skills to fight for expanded voting rights, who was mentored by civil libertarian legislator and federal judge Abner Mikva, who discussed the intricacies of Middle East policy with Edward Said and Rashid Khalidi, and who learned about single-payer health care from his old friend and neighbor Dr. Quentin Young, the longtime coordinator of Physicians for a National Health Program. And, famously, Obama did not just make anti-war sounds before Iraq was invaded, he appeared at an anti-war rally in downtown Chicago with a “War Is Not an Option” sign waving at his side.

Obama knows not just the rough outlines of the left-labor-liberal-progressive agenda, but the specifics. He does not need to be presented with progressive ideas for responding appropriately to an economic downturn, to environmental and energy challenges, to global crises and democratic dysfunctions. He has, over the better part of a quarter century, spoken of, written about, and campaigned for them.

I first covered Obama a dozen years ago, when he was running for the Illinois state senate as a candidate endorsed by the New Party, the labor-left movement of the mid-1990s that declared “the social, economic, and political progress of the United States requires a democratic revolution in America–the return of power to the people.” When we spoke together at New Party events in those days, he was blunt about his desire to move the Democratic Party off the cautious center where Bill Clinton had wedged it. And when we spoke in the years that followed, as he positioned himself for a 2004 U.S. Senate run, Obama told me that he saw Wisconsin Democrat Russ Feingold–the lone dissenter against the Patriot Act–as the best role model in the chamber.

So why not pop the champagne corks and celebrate Obama’s nomination and election as a victory for what the late Paul Wellstone described as “the Democratic wing of the Democratic Party”? Because knowing the ideals and values of the left is not the same as practicing them. As a Senator, Obama did not take Feingold as a role model. In fact, they differed on essential constitutional, trade, and Presidential accountability issues, with Obama consistently taking more cautiously centrist positions. One of Obama’s first votes in the Senate was to confirm Condoleezza Rice as Secretary of State. Dr. Young wrote to his friend. “I told him I was disappointed in him,” the veteran campaigner for peace and social and economic justice recalled. “Rice was the embodiment of everything that was wrong with this Administration. So, he called me back and he said: ‘Why didn’t you pick up the phone and call me? Do you think Bush would ever send to the Senate a nominee for Secretary of State who I could vote for? I said: ‘You are the constitutional lawyer. It’s about advice and consent, right? You should have denied him your consent.’ ”

Young was, of course, right. But the lesson that should be taken away from the Rice vote, and from the many disappointments that have followed it, ought not be that Obama is a hopeless case. In fact, quite the opposite. In that conversation with Young, the Senator outlined the relationship that the left ought to develop with a powerful but as yet ill-defined President.

Obama was nominated and elected in 2008 by progressives, both younger tech-savvy activists who made his candidacy an early favorite of the blogosphere and old-school liberal precinct walkers who saw in his candidacy an extension of the frustrating work of opposing all that was Bush and Cheney. The Senator won the Democratic nomination because he was the only first-tier contender who could say that he had opposed authorizing Bush to take the country to war with Iraq. In the Iowa caucuses that would define the 2008 race, those anti-war credentials, above all other factors, made the young Senator from Illinois a contender.

Similarly, as he campaigned in key states such as Wisconsin, Obama’s call for a new approach to free trade agreements and for massive infrastructure investments allowed him to secure backing from labor and liberal farm activists at critical stages in the process. The progressives who committed to Obama early on were the essential foot soldiers of his long march through the caucuses, the primaries, and the fall campaign. These activists formed a base within the campaign and the Democratic Party, centered on but not limited to the Obama team’s quasi-open website and blog, www.MyBarackObama.com, which did not always cheerlead for the candidate. In June, when Obama broke with Feingold and other Senate progressives to support Bush’s rewrite of the Foreign Intelligence Surveillance Act, the Senator felt enough heat from his own and independent netroots sites that he was compelled to explain himself, making what Obama described as a “firm pledge” that he would revisit the issue as President to shore up privacy protections.

What Internet activists such as OpenLeft.com’s Matt Stoller and Firedoglake.com’s Jane Hamsher did during the FISA fight was roughly equivalent to what Obama told Dr. Young to do back in 2005: “Pick up the phone and call me.” They were undermined by a rally-round-the-candidate mentality that protected Obama during the campaign season. Yet netroots activists made themselves heard and earned a response from candidate Obama. And they can do much more with respect to President Obama. As Hamsher notes, “We can get the public engaged.”

And so they must, especially with that portion of the public that took seriously the candidate’s promise of “change we can believe in.” But to do this effectively, activists cannot wait for Obama to define the playing field. They must assume that he knows what they know. And this requires a radically different approach than the left took to Southern centrist Democratic Presidents such as Bill Clinton and Jimmy Carter.

The way to influence Obama and his Administration is to speak not so much to him as to America. Get out ahead of the new President, and of his spin-drive communications team. Highlight the right appointees and the right responses to deal with the challenges that matter most. Don’t just critique, but rather propose. Advance big ideas and organize on their behalf; identify allies in federal agencies, especially in Congress, and work with them to dial up the pressure for progress. Don’t expect Obama or his aides to do the left thing. Indeed, take a lesson from rightwing pressure groups in their dealings with Republican administrations and recognize that it is always better to build the bandwagon than to jump on board one that is crafted with the tools of compromise.

Smart groups and individuals are already at it. The United Steelworkers union has been way ahead of the curve in critiquing the financial services bailout and in working with Congressional allies such as Ohioans Marcy Kaptur and Dennis Kucinich to challenge the basic assumptions of a top-down bailout. The Laborers union has been promoting a fully developed infrastructure-investment plan that represents a smart stimulus. The American Civil Liberties Union is already prodding Obama to keep a series of promises he made during the campaign with regard to civil liberties and abuses of executive power, and providing concrete examples of how he can do so. The ACLU and other groups will be working with members of the Senate Judiciary Committee such as Feingold to assure that Obama’s Justice Department nominees are asked the right questions.

Perhaps most impressive are the moves made by the California Nurses Association/National Nurses Organizing Committee, Physicians for a National Health Program, and Progressive Democrats of America to ensure that the option of single-payer is not forgotten as Obama and House Speaker Nancy Pelosi establish their domestic policy priorities. To that end, sixty activists from these and allied groups met one week after Election Day at the AFL-CIO headquarters in Washington with Michigan Congressman John Conyers, an early Obama backer and the chief House proponent of real reform, to forge a Single-Payer Healthcare Alliance and plot specific strategies for influencing the new Administration and Congress.

The point won’t be to teach Obama about single-payer. Less than six years ago, he told the Illinois AFLCIO: “I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a singlepayer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Since then, Democrats have taken back the House, the Senate, and the White House. The man who set those prerequisites in 2003 will sit in the Oval Office in 2009.

But change didn’t just come to Washington. It came to Barack Obama. His statements, his strategies, and his appointments evidence a caution born of the political and structural pressures faced by Presidential contenders and Presidents-elect. Whether the previous, more progressive Obama still exists within the man who will take the oath of office on January 20 remains to be seen. But the only way to determine if Obama really is the progressive he claimed as recently as last summer to be is to push not just Obama but the public.

Franklin Roosevelt’s example is useful here. After his election in 1932, FDR met with Sidney Hillman and other labor leaders, many of them active Socialists with whom he had worked over the past decade or more. Hillman and his allies arrived with plans they wanted the new President to implement. Roosevelt told them: “I agree with you, I want to do it, now make me do it.”

It is reasonable for progressives to assume that Barack Obama agrees with them on many fundamental issues. He has said as much.

It is equally reasonable for progressives to assume that Barack Obama wants to do the right thing. But it is necessary for progressives to understand that, as with Roosevelt, they will have to make Obama do it.

John Nichols is associate editor of The Capital Times in Madison, Wisconsin, and Washington correspondent for The Nation. His latest book is “The Genius of Impeachment.”

The Progressive 21 January 2009, http://www.progressive.org/full/magazinearticles

Universal health care local group's preference

Palm Beach Post
Letter to the Editor
Saturday, January 10, 2009

Recently, my wife and I attended one of the meetings requested by Barack Obama to create a document advising the Obama team on health-care action to be taken by the new administration. About a dozen of us met at the Scottish Rites center in Lake Worth, a meeting which had been organized by a retired physician.

I have read about similar meetings around the country, and our result was similar to the others. The consensus was for single-payer, universal health care (improved Medicare for all) although, when one of the attendees broached the subject, several of the others didn’t recognize the concept. By the end of the meeting, the convener was authorized to say in the letter to be submitted that this group recommended the adoption of a single-payer system as described in HR 676, the bill authored by Rep. John Conyers, D-Mich., and co-sponsored by 93 representatives.

ROBERT CROWE
North Palm Beach

Universal health care local group’s preference

Palm Beach Post
Letter to the Editor
Saturday, January 10, 2009

Recently, my wife and I attended one of the meetings requested by Barack Obama to create a document advising the Obama team on health-care action to be taken by the new administration. About a dozen of us met at the Scottish Rites center in Lake Worth, a meeting which had been organized by a retired physician.

I have read about similar meetings around the country, and our result was similar to the others. The consensus was for single-payer, universal health care (improved Medicare for all) although, when one of the attendees broached the subject, several of the others didn’t recognize the concept. By the end of the meeting, the convener was authorized to say in the letter to be submitted that this group recommended the adoption of a single-payer system as described in HR 676, the bill authored by Rep. John Conyers, D-Mich., and co-sponsored by 93 representatives.

ROBERT CROWE
North Palm Beach

Commonwealth – analysis of health care bills

An Analysis of Leading Congressional Health Care Bills, 2007-2008

(Part I, Insurance Coverage)

By Sara R. Collins, Ph.D, Jennifer L. Nicholson, and Sheila D. Rustgi
The Commonwealth Fund
January 2009
Overview
This report analyzes and compares leading bills of the 110th Congress aimed at expanding and improving health insurance coverage. Bills and proposals from members of Congress and President-elect Barack Obama include plans to fundamentally reform the health insurance system through mixed private–public approaches that build on our current system; a public insurance option available to the entire population; bills to change the tax treatment of employer benefits; federal–state partnership to provide grants to states to expand coverage; and bills that would expand coverage for children or disabled individuals, among others. Using analysis from the Lewin Group, the authors provide coverage and cost estimates for the proposed bills, which range from 48.9 million uninsured people gaining coverage to a net loss of coverage for 283,000 people; proposals could increase national health spending by as much as $64.1 billion or create savings of $58.1 billion.
Executive Summary:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=777197
Full report (132 pages):
http://www.commonwealthfund.org/usr_doc/1223_Collins_analysis_cong_bills_2007-2008_part_I_ins_coverage.pdf?section=4039

For those who would like to have a better understanding of the various Congressional approaches to reform, this report is very helpful. The Lewin Group analysis brings reality to the claims being made by the proponents of each approach.
The proposals vary considerably in how effective they are (or are not) in expanding coverage to include everyone. Only one of the proposals evaluated, Representative Pete Stark’s AmeriCare Health Care Act, would be effective in covering everyone. The closest to this would be the Commonwealth (Obama/Baucus) and the Wyden proposals, but they would leave a few million without coverage.
Not only is Stark’s AmeriCare proposal the most effective in expanding coverage, it is also the least expensive in terms of our total National Health Expenditures, actually reducing spending by about $58 billion.
The results are no surprise. Many studies, such as the California Health Care Options Project (a study of nine models of reform) have shown that those models that build on our current system of private and public plans are the most expensive models of reform, and fall short on goals of universality, comprehensiveness, and equity. In contrast, the single payer model and health service model actually accomplish those goals while being the least expensive models of reform (though most Americans would prefer government health insurance to a government-owned health care delivery system).
To be clear, Pete Stark’s AmeriCare is not a single payer model. AmeriCare, an improved and expanded Medicare-like program, would cover 85 percent of us. The existing Medicare program would be improved and cover another 10 percent of us. Qualified employer-sponsored plans would cover 1 percent (yes, only one percent). Dual Eligible and TRICARE would cover the balance. Of the proposals studied, AmeriCare is the closest to single payer, though many single payer advocates would have preferred that Representative John Conyers’ HR 676 single payer bill be included in the analyses.
Perhaps it’s better that it wasn’t since it could have led to a misinterpretation and inevitable misuse of the findings. HR 676 would require that investor-owned providers be converted to not-for-profit status, and that the investors be compensated by public funds at the appraised value of the converted facilities. As only one example, the hospital corporation HCA has a book value of $24 billion. That alone would wipe out close to half of the savings of the Stark proposal.
The importance of this analysis is that, regardless of the politics, it’s the policies that count. Senator Mike Enzi, senior Republican on Senator Kennedy’s Health, Education, Labor and Pensions Committee, says that reform should include the 80 percent of policies on which we agree, and exclude the 20 percent on which we don’t, which is code language for rejecting policies that are not in his plan. His approach, heavily dependent on private plans, is the most expensive of all and yet leaves 22 million people uninsured. He has said, “Forcing private plans to compete with a public program like Medicare, with its price controls and ability to shift costs to private payers, will inevitably doom true competition and could ultimately lead to a single-payer, government-run health care program.”
People are going broke, suffering and even dying, and we continue with academic exercises on ideology-tinged policy options? It’s time to move on beyond the politics of ideology, and finally get into gear with the politics of sound policy. With a health care bill of well over $2 trillion, we need reform that works!

Commonwealth – analysis of health care bills

An Analysis of Leading Congressional Health Care Bills, 2007-2008

(Part I, Insurance Coverage)

By Sara R. Collins, Ph.D, Jennifer L. Nicholson, and Sheila D. Rustgi
The Commonwealth Fund
January 2009

Overview

This report analyzes and compares leading bills of the 110th Congress aimed at expanding and improving health insurance coverage. Bills and proposals from members of Congress and President-elect Barack Obama include plans to fundamentally reform the health insurance system through mixed private–public approaches that build on our current system; a public insurance option available to the entire population; bills to change the tax treatment of employer benefits; federal–state partnership to provide grants to states to expand coverage; and bills that would expand coverage for children or disabled individuals, among others. Using analysis from the Lewin Group, the authors provide coverage and cost estimates for the proposed bills, which range from 48.9 million uninsured people gaining coverage to a net loss of coverage for 283,000 people; proposals could increase national health spending by as much as $64.1 billion or create savings of $58.1 billion.

Executive Summary:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=777197

Full report (132 pages):
http://www.commonwealthfund.org/usr_doc/1223_Collins_analysis_cong_bills_2007-2008_part_I_ins_coverage.pdf?section=4039

Comment:

By Don McCanne, MD

For those who would like to have a better understanding of the various Congressional approaches to reform, this report is very helpful. The Lewin Group analysis brings reality to the claims being made by the proponents of each approach.

The proposals vary considerably in how effective they are (or are not) in expanding coverage to include everyone. Only one of the proposals evaluated, Representative Pete Stark’s AmeriCare Health Care Act, would be effective in covering everyone. The closest to this would be the Commonwealth (Obama/Baucus) and the Wyden proposals, but they would leave a few million without coverage.

Not only is Stark’s AmeriCare proposal the most effective in expanding coverage, it is also the least expensive in terms of our total National Health Expenditures, actually reducing spending by about $58 billion.

The results are no surprise. Many studies, such as the California Health Care Options Project (a study of nine models of reform) have shown that those models that build on our current system of private and public plans are the most expensive models of reform, and fall short on goals of universality, comprehensiveness, and equity. In contrast, the single payer model and health service model actually accomplish those goals while being the least expensive models of reform (though most Americans would prefer government health insurance to a government-owned health care delivery system).

To be clear, Pete Stark’s AmeriCare is not a single payer model. AmeriCare, an improved and expanded Medicare-like program, would cover 85 percent of us. The existing Medicare program would be improved and cover another 10 percent of us. Qualified employer-sponsored plans would cover 1 percent (yes, only one percent). Dual Eligible and TRICARE would cover the balance. Of the proposals studied, AmeriCare is the closest to single payer, though many single payer advocates would have preferred that Representative John Conyers’ HR 676 single payer bill be included in the analyses.

Perhaps it’s better that it wasn’t since it could have led to a misinterpretation and inevitable misuse of the findings. HR 676 would require that investor-owned providers be converted to not-for-profit status, and that the investors be compensated by public funds at the appraised value of the converted facilities. As only one example, the hospital corporation HCA has a book value of $24 billion. That alone would wipe out close to half of the savings of the Stark proposal.

The importance of this analysis is that, regardless of the politics, it’s the policies that count. Senator Mike Enzi, senior Republican on Senator Kennedy’s Health, Education, Labor and Pensions Committee, says that reform should include the 80 percent of policies on which we agree, and exclude the 20 percent on which we don’t, which is code language for rejecting policies that are not in his plan. His approach, heavily dependent on private plans, is the most expensive of all and yet leaves 22 million people uninsured. He has said, “Forcing private plans to compete with a public program like Medicare, with its price controls and ability to shift costs to private payers, will inevitably doom true competition and could ultimately lead to a single-payer, government-run health care program.”

People are going broke, suffering and even dying, and we continue with academic exercises on ideology-tinged policy options? It’s time to move on beyond the politics of ideology, and finally get into gear with the politics of sound policy. With a health care bill of well over $2 trillion, we need reform that works!

New film indicts U.S. health care system

Health, Money and Fear:


A film about our health care system

Why does it cost so much? What does it say about us? What can we do about it? By PNHP staff Dr. Paul Hochfeld, an emergency medicine physician in Corvallis, Ore., has produced and directed a new 47-minute film titled “Health, Money and Fear.” The DVD features interviews with over a dozen physicians, administrators, civic leaders and health policy experts on the problems of today’s U.S. health care “non-system” and the prospects for its reform. Among the people interviewed are Drs. Marcia Angell, Arnold Relman, Leon Eisenberg and Steffie Woolhandler, longtime advocates for single-payer national health insurance. The interviews are interspersed with footage of hospital and street scenes, charts and graphs. The quality of the video rivals that of a public television program. Hochfeld’s film touches on some of the key factors in the rising costs of care, including the administrative waste associated with the private insurance industry, new technology, pressure on physicians to produce profits, liability issues and skyrocketing drug prices. In the words of Hochfeld: “Our health care system is beyond broken or sick. It’s dumb. We spend more than twice as much per capita than most developed countries, the taxpayer is already paying for 60 percent of the total bill, and, by any measure of public health, our results are poor. … As our primary care providers continue to disappear, increasing fragmentation of care, costs will rise and outcomes will worsen. Most significantly, the insurance industry adds nothing to ‘health’ and greatly to total cost, which is increasingly a burden to our economy and threat to the financial solvency of our government. … Our health care system should be more about health and less about profits.” Hochfeld was assisted in producing the film by editor Todd Trigsted. To obtain a copy, e-mail Dr. Hochfeld at phochfeld@msn.com. He requests a donation of $0 to $25. For more information about the film, see this review in Emergency Physicians Monthly [below] or visit www.ourailinghealthcare.com.

Review of Health, Money and Fear

By Logan Plaster DVD review Emergency Physicians Monthly Jan. 7, 2009 Health, Money and Fear Paul Hochfeld had enough. After nearly 30 years practicing emergency medicine in Oregon he was sick and tired of ordering tests that people didn’t need and having no responsible limits on expensive end-of-life care. He felt that the health care system was imploding and he was at the center. So what did he do? He picked up a video camera, of course, and began making a documentary. It didn’t happen overnight. In fact, if you’d told Hochfeld three summers ago, when he enrolled in his first (and only) video production class, that he would be screening his own health care documentary at the 2008 Boston Film Festival, he would have called you delusional. A few years back, Hochfeld was just dabbling, producing small video projects for friends. He traveled to Tanzania to document the building of a new school and then made a video for a humanitarian water project in Kenya. But the bug for Hochfeld’s current project didn’t take hold until the day he saw “Why We Fight,” a documentary by Eugene Jarecki. The film raises questions about the influence of America’s military industrial complex — the largest industry in the country — over public policy. As interesting as this was, for Hochfeld, it pointed to another question: How is the health care system — America’s second largest industry — hijacking public policy? “I think the seeds of the video started with that,” Hochfeld says. Hochfeld didn’t really know where he was heading, but he began with the working title: “Our Ailing Health Care: A Physician Explores the Illness.” At first, he simply went to the library and checked out books and journals, boning up on his facts. “I had never really explored it at that level before,” says Hochfeld. As he came across people in his reading who seemed to have interesting things to say about the health care system, he tracked down their information, contacted them, and asked them if he could conduct an interview. Much to his surprise, most of them said yes. “It was unbelievable actually,” he recalls. Hochfeld ended up arranging seven interviews between Boston and Atlanta. He took a week and half out of his schedule, flew to the East Coast and began traveling from city to city. In terms of production, the original plan was to go simple: two cameras, no operator. Just Hochfeld and the interviewee. “It was going to be a one-man show,” says Hochfeld with a laugh. “Yeah, right.” After realizing that this wasn’t going to cut it, Hochfeld teamed up with another film maker, his instructor from a video production class he’d taken a couple years prior. Hochfeld credits this move with making a “huge difference” in the final product. “I think what makes my video work is that even though it’s just an ER doctor doing it, it does have the feel of a professional production.” Hochfeld completed his interviews in the Spring of 2007, let the tapes sit for the summer, and then entered the editing room last Fall. He whittled and chopped until the piece was a concise 47-minute documentary which he titled “Health, Money and Fear.” These days Paul Hochfeld can be found in Corvallis, Oregon, showing his film to various groups of interested doctors and medical academics. They watch the film and then engage in a discussion of the topics in the film. It’s a grassroots effort, but Hochfeld couldn’t be happier with the result. “People really like it,” says Hochfeld. “I think it resonates with a lot of people’s truth.” That “truth,” as portrayed by the film, is the idea that a single-payor health care system could save the country untold millions of dollars through such avenues as liability reform, a national EMR, regulations put on pharmaceutical pricing, and adequate pay for primary care physicians. “Our health care system is a bizarre blend of the worst of capitalism and the worst of socialism,” says Hochfeld. On the socialist side, he explains, you have the patient “with chest pain who one year previously received a cardiac stint on public money who is still smoking, expecting us to do it again.” On the capitalist side, “you have hospitals spending huge amounts of money on proton beam accelerators to marginally help old men have longer survival from prostate cancer, because it pays well, not because it is a good investment of our health care dollars.” When he gets back from the Boston Film Festival, Hochfeld plans to contact those people who have shown an interest in the film and pursue a multi-city tour in which he shows the video and leads discussions around the country. He doesn’t care about getting paid; he’s asking only that his traveling expenses be covered. His aim is simple: use the film as an educational device and a political tool to affect real health care change. Hochfeld concludes the film with this plea: “We need to get over our fear of the government and embrace the idea that in health care, somebody needs to be in charge, so that we can keep our eye on the prize, which is health, not profits.”

CMS requirements for medical suppliers – a bureaucratic boondoggle?

Change in law costs medical supply firms

By Karen Shideler
The Wichita Eagle
January 8, 2009
Businesses that provide durable medical equipment, such as hospital beds and bottled oxygen, are being hit by more paperwork and new costs because of new federal requirements.
The Centers for Medicare and Medicaid Services are requiring most durable medical equipment suppliers to post a surety bond of $50,000 and to be accredited.
The federal requirements are, in part, the result of efforts to fight Medicare fraud and abuse. Medicare recently announced that it was revoking billing privileges of more than 1,100 medical equipment suppliers in south Florida and the Los Angeles area after an investigation found about $1 billion in improper payments.
In a news release, CMS acting administrator Kerry Weems said, “We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare.”
“It’s more work and, let’s face it, it’s money out of our pocket,” said Leon Deaver, owner of Kimzey-Eilert Medical Supplies.
Bruce Schneider, owner and pharmacist at Hart Pharmacy & Home Medical Equipment, estimated the new requirements will cost him $20,000.
Brian Dechant, director of sales at Therapeutic Medical Supply, said the accreditation requirement doubles or triples the amount of paperwork required.
“If you’re running your operations like you should be, it’s not a real big thing,” Dechant said. He said his company was recently accredited for a three-year period. “It requires you to follow a certain set of standards… They review them, make sure everything’s kosher, then they actually look at our processes.”
Schneider said he has seen estimates that 28 percent of medical equipment suppliers nationwide could be out of business a year from now because of the new requirements.
But he and Dechant both said they expected the number in Wichita to hold steady. “We’re generally honest, good people,” Dechant said.
He, Schneider and Deaver all said the new requirements aren’t all bad.
For Schneider, they’ve resulted in some streamlining.
Deaver said they should help assure customers, too.
“We’re taking a very positive attitude, that it will help us do things better,” he said.
http://www.kansas.com/business/health-care/story/655455.html

A frequent complaint about government financing of health care is that government bureaucrats place an excessive administrative burden on the health care delivery system. This charge has already been refuted by studies demonstrating the much greater administrative excesses and waste of the private insurance industry when contrasted with a public program such as Medicare.
Nevertheless, when the government introduces a program to improve value in health care purchasing, such as this program to accredit medical equipment suppliers, howls of protest arise from the anti-government forces. This article on “more paperwork and new costs because of new federal requirements” provides these protesters with more support. Or does it?
It is only natural that honest businessmen who are trying to provide quality products and services would be annoyed with new government requirements. But they understand that the taxpayers should not be expected to pay a billion dollars to crooks that permeate their own industry. They also admit that these new requirements “aren’t all bad,” that they have motivated “some streamlining,” and that they will help “assure customers” of the integrity of this industry that has been given a black eye by the the nefarious element amongst them.
How would the private insurance industry have handled this? Would they have used their very large pool of administrative funds to require accreditation and surety bonds of the suppliers? No. They use their administrative funds to write and market innovative plans that don’t even cover these supplies and services. When they do provide this coverage with premium plans, they burn up more administrative dollars to be sure that they sell these more comprehensive plans only to those healthy individuals who would be less likely to need these benefits. An obvious irony is that these administrative costs for the private insurers are much greater than would be a program of accreditation and surety bonds.
Never fear. As with other Medicare administrative efficiencies, the private insurers will get a free ride by using the Medicare lists of accredited suppliers. Once again, the taxpayer foots the bill, while the private insurers take their spoils to the bank.

CMS requirements for medical suppliers – a bureaucratic boondoggle?

Change in law costs medical supply firms

By Karen Shideler
The Wichita Eagle
January 8, 2009

Businesses that provide durable medical equipment, such as hospital beds and bottled oxygen, are being hit by more paperwork and new costs because of new federal requirements.

The Centers for Medicare and Medicaid Services are requiring most durable medical equipment suppliers to post a surety bond of $50,000 and to be accredited.

The federal requirements are, in part, the result of efforts to fight Medicare fraud and abuse. Medicare recently announced that it was revoking billing privileges of more than 1,100 medical equipment suppliers in south Florida and the Los Angeles area after an investigation found about $1 billion in improper payments.

In a news release, CMS acting administrator Kerry Weems said, “We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare.”

“It’s more work and, let’s face it, it’s money out of our pocket,” said Leon Deaver, owner of Kimzey-Eilert Medical Supplies.

Bruce Schneider, owner and pharmacist at Hart Pharmacy & Home Medical Equipment, estimated the new requirements will cost him $20,000.

Brian Dechant, director of sales at Therapeutic Medical Supply, said the accreditation requirement doubles or triples the amount of paperwork required.

“If you’re running your operations like you should be, it’s not a real big thing,” Dechant said. He said his company was recently accredited for a three-year period. “It requires you to follow a certain set of standards… They review them, make sure everything’s kosher, then they actually look at our processes.”

Schneider said he has seen estimates that 28 percent of medical equipment suppliers nationwide could be out of business a year from now because of the new requirements.

But he and Dechant both said they expected the number in Wichita to hold steady. “We’re generally honest, good people,” Dechant said.

He, Schneider and Deaver all said the new requirements aren’t all bad.

For Schneider, they’ve resulted in some streamlining.

Deaver said they should help assure customers, too.

“We’re taking a very positive attitude, that it will help us do things better,” he said.

http://www.kansas.com/business/health-care/story/655455.html

Comment:

By Don McCanne, MD

A frequent complaint about government financing of health care is that government bureaucrats place an excessive administrative burden on the health care delivery system. This charge has already been refuted by studies demonstrating the much greater administrative excesses and waste of the private insurance industry when contrasted with a public program such as Medicare.

Nevertheless, when the government introduces a program to improve value in health care purchasing, such as this program to accredit medical equipment suppliers, howls of protest arise from the anti-government forces. This article on “more paperwork and new costs because of new federal requirements” provides these protesters with more support. Or does it?

It is only natural that honest businessmen who are trying to provide quality products and services would be annoyed with new government requirements. But they understand that the taxpayers should not be expected to pay a billion dollars to crooks that permeate their own industry. They also admit that these new requirements “aren’t all bad,” that they have motivated “some streamlining,” and that they will help “assure customers” of the integrity of this industry that has been given a black eye by the the nefarious element amongst them.

How would the private insurance industry have handled this? Would they have used their very large pool of administrative funds to require accreditation and surety bonds of the suppliers? No. They use their administrative funds to write and market innovative plans that don’t even cover these supplies and services. When they do provide this coverage with premium plans, they burn up more administrative dollars to be sure that they sell these more comprehensive plans only to those healthy individuals who would be less likely to need these benefits. An obvious irony is that these administrative costs for the private insurers are much greater than would be a program of accreditation and surety bonds.

Never fear. As with other Medicare administrative efficiencies, the private insurers will get a free ride by using the Medicare lists of accredited suppliers. Once again, the taxpayer foots the bill, while the private insurers take their spoils to the bank.

Conyers: Obama should not nominate Sanjay Gupta

By Sam Stein
Huffington Post
January 8, 2009

Rep. John Conyers has written a letter to Democratic colleagues urging them to join him in publicly opposing the nomination of Dr. Sanjay Gupta for Surgeon General.

Conyers, the veteran Judiciary Committee chairman, writes that Gupta “lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance,” and requests that fellow Democrats join him “in signing a letter to President-Elect Barack Obama that Dr. Sunjay Gupta not be nominated for the post.”

Here’s the bulk of the Dear Colleague letter:

“I join in opposition with respected Noble Peace Prize award wining economist Paul Krugman, who has very serious concerns with having Dr. Gupta be the nation’s Surgeon General. […]

“Also, there are highly experienced medical professionals who question whether Dr. Gupta has the necessary experience or even the medical background to be in charge of some 6,000 physicians or more who work in the United States Public Health Service. Gerard M. Farrel, executive director of the Commissioned Officers Association, stated in the January 7, 2008, Washington Post that Dr. Gupta will certainly face a ‘credibility gap’ because he never served in the National Health Service Corps, and furthermore, does not have the ‘experience or qualifications to be the leader of the nation’s public health service.’ Clearly, it is not in the best interests of the nation to have someone like this who lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance to some of the poorest and most underserved communities in America.”

Conyers’ letter represents one of the first critical takes on the potential Gupta nomination to come from the Hill. In most quarters, reports about the CNN medical correspondent have been greeted as a smart, if not provocative, pick. Howard Dean, a doctor himself, noted that Gupta’s responsibilities would be much the same as those in his current job: explaining medical issues of public concern in a manner that the public could understand.

Outside of government, however, some have begun questioning whether the CNN correspondent has the proper qualifications to be Surgeon General. Krugman, in his post noted that Gupta accused filmmaker Michael Moore of inaccuracies, “when the truth was that on every one of the allegedly fudged facts, Moore was actually right and CNN was wrong.” Gupta and CNN would later acknowledge making a mistake and apologize on air. Others have questioned whether he is the right conduit for Obama’s health care agenda, and whether or not he has ethical conflicts of interest stemming from the corporate sponsors of his show.

But while Conyers and these individuals have doubts, it’s unclear whether the post of Surgeon General will elicit much of a fight, since no Senators (who must confirm the nomination) have spoken critically of Gupta.

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009
(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.
For many Texans, it hasn’t worked out that way.
“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.
Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.
Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.
“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.
“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”
Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.
Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.
“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”
The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”
http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.
Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?
And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.
Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009

(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.

For many Texans, it hasn’t worked out that way.

“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.

Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.

Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.

“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.

“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”

Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.

Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.

“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”

The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”

http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

Comment:

By Don McCanne, MD

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.

Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?

And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.

Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?