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Yikes!!! I'm a Slave to Socialized Medicine

Yikes!!! I'm a Slave to Socialized Medicine

by: Steve Weissman
t r u t h o u t | Perspective
Friday 21 November 2008

http://www.truthout.org/112108A

Growing up in Florida in the 1940s, I saw many of the doctors my family knew fighting against Harry Truman’s effort to enact what they called “Socialized Medicine.” Their immediate target was Sen. Claude Pepper, a New Deal Democrat who supported universal health care. Our doctor friends dubbed him “Red Pepper” and helped defeat him in the elections of 1950. Yet, for all this early “fight for freedom,” I now find myself in France enjoying single-payer, socialized medicine, which I would heartily recommend to all Americans.

The system here is surprisingly nonbureaucratic, at least for the patient. My wife Anna and I picked our own general practitioners (GPs), specialists and hospital care, with no insurance company restricting us to their list of doctors or hospitals. In fact, we found only two restrictions. The GPs could turn us down if they already had too many patients and they had to be within our geographical area so they would not have to travel too far when making a house call. Yes, under socialized medicine here in France, doctors still make house calls, even here in the boondocks where we live.

Nurses also make house calls to give shots or take blood for testing. Test results usually arrive in the next day’s mail.

For each visit to the GP, we write a check for 22 euros. The system then reimburses us for 70 percent with a direct deposit to our bank account. For some particularly debilitating conditions, the government system pays the full 100 percent. To pay whatever the government doesn’t, most people here have private top-up insurance, which is very reasonably priced. So, the single-payer system has more than a single payer, but the insurance companies exercise none of the control they would back home.

At the pharmacy, we don’t pay at all. We simply present our health service cards: the government and top-up insurance then pay the pharmacist directly. The system excludes certain nonnecessary medicines and requires that we use generic medicine when available.

For most visits to specialists, test facilities or hospitals, the GP acts as a gatekeeper, writing prescriptions and often a letter explaining particular problems. He or she does all this on the spot during office visits, and there’s none of the paper shuffling one sees in doctors’ offices everywhere in America.

Most specialists and test-givers also write up their reports on the spot and hand them directly to the patient, though x-rays and other test results will soon be transmitted to the GP by computer. Again, we’ve seen very little bureaucracy and no interference by either the government or insurance companies.

None of this is free, of course. Everyone in the workforce pays a percentage of their taxable income to cover this, their pensions, and other social charges. For Anna and me, the costs are covered by our British pensions from the time we lived and worked in England.

How good is the French medical care? Surveys by the World Health Organization rate the French system as the best in the world, and far better than average health care in the United States. Life expectancy and most other relevant rankings are also higher in France than in the United States.

From our own experience, we would agree that French medicine is much better and far cheaper than in the United States. When we lived in Florida, my very expensive heart specialist seemed content for me to have a bit of high blood pressure, which he saw as natural for a person of my age. Not so here in France, where the doctors kept changing my pills until they got me down to the normal 120 over 80. The French doctors also found a way to end a long-standing enlargement of my heart that never bothered my American doctors.

To be fair, not all doctors here are as good as the ones who’ve treated us, and we’ve heard the same kind of horror stories we heard in the States about doctors who buried their mistakes. We also hear threats to cut back funding, which is already far less per head than spending on medical care in the United States. But, so far, we’ve gotten the best of care, as do all our neighbors, including workmen, farmers and retirees on limited budgets.

Why, then, can’t Americans have the same kind of socialized medicine? Mostly, because of the health maintenance organizations and insurance companies, who take such a big slice off the top. So strong is their influence that almost no one of any clout in American politics dares to talk of a single-payer system that would simply do away with private medical insurance, except perhaps as the kind of top-up they have here.

Hopefully, if enough Americans get to know what exists here in France, the debate will open up. Something like the French system would certainly save Americans a great deal of money and provide much better care.

But, for Anna and me, it’s already too late. We’ve become so enslaved by the great medical care we now have that we cannot see ever moving back to the United States or anywhere else. That, I suppose, is the true horror of socialized medicine that all those Florida doctors warned about back in the 1940s.

A veteran of the Berkeley Free Speech Movement and the New Left monthly Ramparts, Steve Weissman lived for many years in London, working as a magazine writer and television producer. He now lives and works in France.

Why I won't join the American Medical Association

by donag
Daily Kos
Sat Nov 22, 2008 at 11:17:57 AM PST

I read the 2008 AMA Reform Proposal. As a result I sent an unsolicited comment to their Member Center. I thought I would share this with you. It was longer than their 1,000 characters and couldn’t contain non-alphabeltical characters (e.g. hyperlinks), so I sent them part 1 and part 2.

Comment: Part 1. I have not joined the AMA in the past 18 years of medical practice for 3 reasons:

1. not subscribing to a single-payer/universal access health care insurance system.

2. poor ethics of the AMA in terms of receipt of outside sponsorship

3. putting the profession in a bad light with its unseemly lobbying on The Hill in concert with Big Pharma and HMOs/insurance industry.

The 2008 AMA proposal on reform is too little to late. It does not focus on universal access, affordability or quality. It is just another way of maintaining high fees for physicians who do procedures and benefits its unholy association with big pharma and HMOs/insurance industry.

Comment: Part 2: I am a local leader in healthcare and will not endorse your organization, but will continue to advocate for Physicians for a National Health Program. It is my advice to my colleagues to support that organization and not the AMA who are now one of the biggest obstructions to healthcare justice. I am unable to include hyperlinks to some excellent critiques of your Proposal on Reform in this note as you can’t include non-alphabetic characters.

I will continue to watch future AMA proposals, but it is time the AMA stopped this PR approach to their tarnished image and proposed some real healthcare reform.

Yikes!!! I’m a Slave to Socialized Medicine

by: Steve Weissman
t r u t h o u t | Perspective
Friday 21 November 2008

http://www.truthout.org/112108A

Growing up in Florida in the 1940s, I saw many of the doctors my family knew fighting against Harry Truman’s effort to enact what they called “Socialized Medicine.” Their immediate target was Sen. Claude Pepper, a New Deal Democrat who supported universal health care. Our doctor friends dubbed him “Red Pepper” and helped defeat him in the elections of 1950. Yet, for all this early “fight for freedom,” I now find myself in France enjoying single-payer, socialized medicine, which I would heartily recommend to all Americans.

The system here is surprisingly nonbureaucratic, at least for the patient. My wife Anna and I picked our own general practitioners (GPs), specialists and hospital care, with no insurance company restricting us to their list of doctors or hospitals. In fact, we found only two restrictions. The GPs could turn us down if they already had too many patients and they had to be within our geographical area so they would not have to travel too far when making a house call. Yes, under socialized medicine here in France, doctors still make house calls, even here in the boondocks where we live.

Nurses also make house calls to give shots or take blood for testing. Test results usually arrive in the next day’s mail.

For each visit to the GP, we write a check for 22 euros. The system then reimburses us for 70 percent with a direct deposit to our bank account. For some particularly debilitating conditions, the government system pays the full 100 percent. To pay whatever the government doesn’t, most people here have private top-up insurance, which is very reasonably priced. So, the single-payer system has more than a single payer, but the insurance companies exercise none of the control they would back home.

At the pharmacy, we don’t pay at all. We simply present our health service cards: the government and top-up insurance then pay the pharmacist directly. The system excludes certain nonnecessary medicines and requires that we use generic medicine when available.

For most visits to specialists, test facilities or hospitals, the GP acts as a gatekeeper, writing prescriptions and often a letter explaining particular problems. He or she does all this on the spot during office visits, and there’s none of the paper shuffling one sees in doctors’ offices everywhere in America.

Most specialists and test-givers also write up their reports on the spot and hand them directly to the patient, though x-rays and other test results will soon be transmitted to the GP by computer. Again, we’ve seen very little bureaucracy and no interference by either the government or insurance companies.

None of this is free, of course. Everyone in the workforce pays a percentage of their taxable income to cover this, their pensions, and other social charges. For Anna and me, the costs are covered by our British pensions from the time we lived and worked in England.

How good is the French medical care? Surveys by the World Health Organization rate the French system as the best in the world, and far better than average health care in the United States. Life expectancy and most other relevant rankings are also higher in France than in the United States.

From our own experience, we would agree that French medicine is much better and far cheaper than in the United States. When we lived in Florida, my very expensive heart specialist seemed content for me to have a bit of high blood pressure, which he saw as natural for a person of my age. Not so here in France, where the doctors kept changing my pills until they got me down to the normal 120 over 80. The French doctors also found a way to end a long-standing enlargement of my heart that never bothered my American doctors.

To be fair, not all doctors here are as good as the ones who’ve treated us, and we’ve heard the same kind of horror stories we heard in the States about doctors who buried their mistakes. We also hear threats to cut back funding, which is already far less per head than spending on medical care in the United States. But, so far, we’ve gotten the best of care, as do all our neighbors, including workmen, farmers and retirees on limited budgets.

Why, then, can’t Americans have the same kind of socialized medicine? Mostly, because of the health maintenance organizations and insurance companies, who take such a big slice off the top. So strong is their influence that almost no one of any clout in American politics dares to talk of a single-payer system that would simply do away with private medical insurance, except perhaps as the kind of top-up they have here.

Hopefully, if enough Americans get to know what exists here in France, the debate will open up. Something like the French system would certainly save Americans a great deal of money and provide much better care.

But, for Anna and me, it’s already too late. We’ve become so enslaved by the great medical care we now have that we cannot see ever moving back to the United States or anywhere else. That, I suppose, is the true horror of socialized medicine that all those Florida doctors warned about back in the 1940s.

A veteran of the Berkeley Free Speech Movement and the New Left monthly Ramparts, Steve Weissman lived for many years in London, working as a magazine writer and television producer. He now lives and works in France.

Why I won’t join the American Medical Association

by donag
Daily Kos
Sat Nov 22, 2008 at 11:17:57 AM PST

I read the 2008 AMA Reform Proposal. As a result I sent an unsolicited comment to their Member Center. I thought I would share this with you. It was longer than their 1,000 characters and couldn’t contain non-alphabeltical characters (e.g. hyperlinks), so I sent them part 1 and part 2.

Comment: Part 1. I have not joined the AMA in the past 18 years of medical practice for 3 reasons:

1. not subscribing to a single-payer/universal access health care insurance system.

2. poor ethics of the AMA in terms of receipt of outside sponsorship

3. putting the profession in a bad light with its unseemly lobbying on The Hill in concert with Big Pharma and HMOs/insurance industry.

The 2008 AMA proposal on reform is too little to late. It does not focus on universal access, affordability or quality. It is just another way of maintaining high fees for physicians who do procedures and benefits its unholy association with big pharma and HMOs/insurance industry.

Comment: Part 2: I am a local leader in healthcare and will not endorse your organization, but will continue to advocate for Physicians for a National Health Program. It is my advice to my colleagues to support that organization and not the AMA who are now one of the biggest obstructions to healthcare justice. I am unable to include hyperlinks to some excellent critiques of your Proposal on Reform in this note as you can’t include non-alphabetic characters.

I will continue to watch future AMA proposals, but it is time the AMA stopped this PR approach to their tarnished image and proposed some real healthcare reform.

Is administrative savings a myth?

5 Myths on Our Sick Health Care System

By Shannon Brownlee and Ezekiel Emanuel
The Washington Post
November 23, 2008 (Web posting Nov. 21)
… we dispel a few myths about how health care works and how much reform Americans are willing to stomach.
3. We would save a lot if we could cut the administrative waste of private insurance.
The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn’t really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Following heart-attack or cancer patients to see which interventions work best is an administrative cost, but it’s also invaluable if you want to improve care. Tracking the rate of heart attacks from drugs such as Avandia is key to ensuring safe pharmaceuticals.
Let’s just say that we could wave a magic wand and cut private insurers’ overhead by half, to what the Canadian government spends on administering its health-care system — 15 percent. How much would we save? Not as much as you may think. Private insurers pay a little more than a third of what we spend on health care, which means that we’d cut a little more than 5 percent from our total budget, or about $124 billion. That’s not peanuts, but it’s not even enough to cover everybody who’s currently uninsured.
More to the point, we only get to save it once. That’s because administrative waste isn’t what’s driving health-care costs up faster than inflation. Most of the relentless rise can be attributed to the expansion of hospitals and other health-care sectors and the rapid adoption of expensive new technologies — new drugs, devices, tests and procedures. Unfortunately, only a fraction of all that new stuff offers dramatically better outcomes. If we’re worried about costs, we have to ask whether a $55,000 drug that prolongs the lives of lung cancer patients for an average of a few weeks is really worth it. Unless we find a cure for our addiction to the new but not necessarily improved, our national medical bill will continue to skyrocket, regardless of how efficient insurance companies become.
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/20/AR2008112002420.html

The authors understand that a single payer or “Medicare for all” model of reform is the most rational competitor to their preferred model of reform – thus their attack on the administrative savings that a single payer system would bring us. They concede that the savings are not a myth as they are considerable, but they still understate the savings because they exclude the tremendous financial burden that our dysfunctional, fragmented, multi-payer system places on the health care delivery system. They also incorrectly state that the administrative savings are a one-time event. In fact, the efficiencies that are achieved are permanent, shifting the trajectory of health care cost increases downward.
Their dismissal of single payer reform (see Emanuel’s “Healthcare, Guaranteed”) as merely an inadequate administrative measure, considering the complexity of the systemic problems in our health care delivery system, ignores the most important benefit of the single payer model. A single payer system creates our own public monopsony, or single purchaser of health care services. Many economists agree that, by controlling the spending of our health care dollars, we can finally demand value in our health care purchasing, introducing infrastructure changes that will lead to the high-performance system for which we are already paying, but not experiencing.
Because Medicare controls health care spending for only about 15 percent of our population, it is a very weak monopsony. Nevertheless it has been able to introduce some spending efficiencies. Think of how effective it would be if it covered all of us.
Medicare is our most popular, most efficient, and most equitable health care financing program, yet it is being dismissed as a model for all of us because of the idea that it somehow represents an ideological extreme. In health care, political compromise based on ideology is not only bankrupting individuals, it is killing them.
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/20/AR2008112002420_Comments.html
11/21/2008 12:36:15 PM

Is administrative savings a myth?

5 Myths on Our Sick Health Care System

By Shannon Brownlee and Ezekiel Emanuel
The Washington Post
November 23, 2008 (Web posting Nov. 21)

… we dispel a few myths about how health care works and how much reform Americans are willing to stomach.

3. We would save a lot if we could cut the administrative waste of private insurance.

The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn’t really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Following heart-attack or cancer patients to see which interventions work best is an administrative cost, but it’s also invaluable if you want to improve care. Tracking the rate of heart attacks from drugs such as Avandia is key to ensuring safe pharmaceuticals.

Let’s just say that we could wave a magic wand and cut private insurers’ overhead by half, to what the Canadian government spends on administering its health-care system — 15 percent. How much would we save? Not as much as you may think. Private insurers pay a little more than a third of what we spend on health care, which means that we’d cut a little more than 5 percent from our total budget, or about $124 billion. That’s not peanuts, but it’s not even enough to cover everybody who’s currently uninsured.

More to the point, we only get to save it once. That’s because administrative waste isn’t what’s driving health-care costs up faster than inflation. Most of the relentless rise can be attributed to the expansion of hospitals and other health-care sectors and the rapid adoption of expensive new technologies — new drugs, devices, tests and procedures. Unfortunately, only a fraction of all that new stuff offers dramatically better outcomes. If we’re worried about costs, we have to ask whether a $55,000 drug that prolongs the lives of lung cancer patients for an average of a few weeks is really worth it. Unless we find a cure for our addiction to the new but not necessarily improved, our national medical bill will continue to skyrocket, regardless of how efficient insurance companies become.

Comments:

By Dr. Don McCanne, MD

The authors understand that a single payer or “Medicare for all” model of reform is the most rational competitor to their preferred model of reform – thus their attack on the administrative savings that a single payer system would bring us. They concede that the savings are not a myth as they are considerable, but they still understate the savings because they exclude the tremendous financial burden that our dysfunctional, fragmented, multi-payer system places on the health care delivery system. They also incorrectly state that the administrative savings are a one-time event. In fact, the efficiencies that are achieved are permanent, shifting the trajectory of health care cost increases downward.

Their dismissal of single payer reform (see Emanuel’s “Healthcare, Guaranteed”) as merely an inadequate administrative measure, considering the complexity of the systemic problems in our health care delivery system, ignores the most important benefit of the single payer model. A single payer system creates our own public monopsony, or single purchaser of health care services. Many economists agree that, by controlling the spending of our health care dollars, we can finally demand value in our health care purchasing, introducing infrastructure changes that will lead to the high-performance system for which we are already paying, but not experiencing.

Because Medicare controls health care spending for only about 15 percent of our population, it is a very weak monopsony. Nevertheless it has been able to introduce some spending efficiencies. Think of how effective it would be if it covered all of us.

Medicare is our most popular, most efficient, and most equitable health care financing program, yet it is being dismissed as a model for all of us because of the idea that it somehow represents an ideological extreme. In health care, political compromise based on ideology is not only bankrupting individuals, it is killing them.

11/21/2008 12:36:15 PM

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/20/AR2008112002420.html

Officials advocate for single payer health care

By Scott Merzbach
Amherst Bulletin
Published on November 21, 2008

If a new presidential administration in Washington, D.C., could do one thing to help Amherst’s budget problems, it might be to solve the issue of rising health care costs for municipal employees, according to town officials.

Town Manager Larry Shaffer said the expected cash shortfall Amherst has experienced in recent years is being driven almost exclusively by escalating health care costs. Shaffer estimates that 12 to 13 cents of every dollar the town spends goes toward health care.

If the country had a single-payer health care system or some other form of nationalized health care, this would provide the most immediate financial relief possible to a town like Amherst, which is facing a projected $2.66 million gap between revenues and expenses in next year’s budget. “If you’re looking for the home run, that’s the home run,” Shaffer said.

Select Board member Diana Stein said the municipal health budget is $2.7 million, and rises to $11 million when school employees are added in. Having a universal, publicly financed health care would help.

Stein said these health care costs could be removed from the budget through a single-payer system.

A letter to our new president

By Susanne L. King, M.D.
Berkshire Eagle
Wednesday, November 19

Dear President-elect Obama:

As you prepare to begin your presidency during a period of severe recession, you will be searching to make financially sound decisions for our country. You have promised to reform the health care system, and only one solution will enable you to create an effective system and save money: a single-payer national health program.

During your campaign, you proposed a health plan to extend coverage to the 45 million uninsured Americans by expanding private and public programs, with the help of federal subsidies and mandates. This will only add to the cost of our health insurance system, currently a hefty $7,129 per person. However, if we adopt a single-payer national health program rather than attempting to expand our dysfunctional multiple payer, private insurance system, we would save money.

Drs. David Himmelstein and Steffie Woolhandler, health care researchers at Harvard Medical School, have calculated that the United States could save $350 billion/year by adopting a single-payer national health program. A single-payer program would eliminate private insurance companies and the enormous expense of their administrative costs and profits.

Every other industrialized country in the world has a national health plan that covers everyone and is administered by the government. And other countries spend less than half as much per person on health care as we do in the United States. One reason they are able to provide health care for everyone for much less money is because their administrative costs are a small fraction of the costs in our country.

A single-payer national health program would also be a real boon to individuals faced with rapidly rising health insurance costs, and would rescue people who are falling into bankruptcy and are losing their homes because of medical debts. American automakers might not need bailouts if they didn’t have to provide insurance for their workers and retirees. Small businesses would no longer shoulder the expense and administrative burden of providing health insurance for their workers.

Not only would we save money for the government, business, and the individual, but a single-payer national health program would also cover everyone, and we would all have access to more comprehensive benefits. These benefits would include medical care, mental health care, dental care, prescription drugs, and long-term care, which is a primary concern for the baby boomers who have been watching their life savings and retirement funds evaporate with the collapse of Wall Street.

A group of 15,000 U.S. doctors in the organization Physicians for a National Health Program have called on you to enact a single-payer program. A Massachusetts poll revealed that 64 percent of doctors support single-payer health care, and the American College of Physicians has voted its support for a national health program as well.

As a Massachusetts resident, I am witnessing an attempt at health care reform that has similarities to your proposed plan, and is being touted as a model for our country. This program has expanded health insurance coverage to people who were previously uninsured, but it is not economically sustainable for our state government or for individuals. Many people are unhappy with the current health insurance program in Massachusetts, which has not reduced rapidly rising premium costs, co-payments and deductibles for the working individual. Massachusetts residents who were able to vote on local ballot initiatives in their legislative districts on Nov. 4, supported single-payer health care by landslide margins. Opinion polls also show that two-thirds of the public supports this kind of reform.

You have a mandate from the American people, and from many doctors and other health care professionals who actually provide our care. You have the opportunity to seize this moment of economic crisis, and create financially sound, sustainable health care reform. As Dr. Quentin Young, a long-time single-payer advocate, has said, “Adopting a nationwide single-payer system will build on the great achievement of Medicare, further unify our people, strengthen our country’s economic competitiveness and assure President Obama’s legacy as an American hero.”

Susanne L. King is a Lenox-based practitioner.

Why Does U.S. Health Care Cost So Much? (Part II: Indefensible Administrative Costs)

By Uwe E. Reinhardt
New York Times
November 21, 2008, 10:34 am

In my previous blog post, I showed that America suffers from “excess spending” in its health care system. Here I will discuss one factor that drives up that spending: indefensibly high administrative costs.

To review: “Excess health spending” in this context refers to the difference between what a country spends per person on health care, and what the country’s gross domestic product per person should predict that that country would spend. (The prediction is based on trends in other countries in the Organization for Economic Cooperation and Development.) The word “excess” here should not be taken as “excessive” unless one could demonstrate that what the other O.E.C.D. nations spend is appropriate and what we spend is ipso facto wasteful.

The United States spends nearly 40 percent more on health care per capita than its G.D.P. per capita would predict. Given the sheer magnitude of the estimated excess spending, it is fair to ask American health care providers what extra benefits the American people receive in return for this enormous extra spending. After all, translated into total dollar spending per year, this excess spending amounted to $570 billion in 2006 and about $650 billion in 2008. The latter figure is over five times the estimated $125 billion or so in additional health spending that would be needed to attain truly universal health insurance coverage in this country.

One thing Americans do buy with this extra spending is an administrative overhead load that is huge by international standards. The McKinsey Global Institute estimated that excess spending on “health administration and insurance” accounted for as much as 21 percent of the estimated total excess spending ($477 billion in 2003). Brought forward, that 21 percent of excess spending on administration would amount to about $120 billion in 2006 and about $150 billion in 2008. It would have been more than enough to finance universal health insurance this year.

The McKinsey team estimated that about 85 percent of this excess administrative overhead can be attributed to the highly complex private health insurance system in the United States. Product design, underwriting and marketing account for about two-thirds of that total. The remaining 15 percent was attributed to public payers that are not saddled with the high cost of product design, medical underwriting and marketing, and that therefore spend a far smaller fraction of their total spending on administration.

Two studies using more detailed bilateral comparisons of two countries illustrate even more sharply the magnitude of our administrative burden relative to that in other developed countries.

One of these is an earlier McKinsey study explaining the difference in 1990 health spending in West Germany and in the United States. The researchers found that in 1990 Americans received $390 per capita less in actual health care but spent $360 more per capita on administration.

A second, more recent study of administrative costs in the American and Canadian health systems was published in 2003 by Steffie Woolhandler and David Himmelstein in The New England Journal of Medicine in 2003. The study used a measure of administrative costs that includes not only the insurer’s costs, but also the costs borne by employers, health-care providers and governments — but not the value of the time patients spent claiming reimbursement. These authors estimated that in 1999, Americans spent $1,059 per capita on administration compared with only $307 in purchasing power parity dollars (PPP $) spent in Canada.

More and more Americans are being priced out of health care as we know it. The question is how long American health policy makers, and particularly the leaders of our private health insurance, can justify this enormous and costly administrative burden to the American people and to the harried providers of health care.

Uwe E. Reinhardt is an economist at Princeton.

AHIP & BCBSA support guaranteed issue and individual mandate

Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate

AHIP (America’s Health Insurance Plans)
November 19, 2008
Summary of AHIP’s Proposal to Guarantee Coverage for Pre-existing Conditions and Promote Affordability in the Individual Insurance Market:

  • Guarantee-issue coverage with no pre-existing condition exclusions;
  • Establish an individual coverage requirement with an insurance coverage verification system, an automatic enrollment process and effective enforcement of the requirement that all individuals purchase and maintain coverage;
  • Promote affordability by: providing refundable, advanceable tax credits for moderate-income individuals and working families; and promoting tax equity whether coverage is obtained through an employer or the individual market; and
  • Ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.

http://www.ahip.org/content/pressrelease.aspx?docid=25068

And…

BCBSA Announces Support for Individual Mandate Coupled with a Requirement for Insurers to Offer Coverage to All

BlueCross BlueShield Association (BCBSA)
November 19, 2008
To assure truly meaningful reform, the Blue Cross and Blue Shield Association (BCBSA) and the 39 member Blue Cross and Blue Shield companies today announced support for every individual being required to have coverage and all insurers being required to accept everyone regardless of their health status.
http://www.bcbs.com/news/bcbsa/bcbsa-announces-support-for.html

If anyone has any remaining doubt that comprehensive reform is close at hand, just look at the response of the private insurance industry. AHIP, representing 1,300 insurance companies, and BlueCross BlueShield Association, insuring over 100 million individuals, in simultaneous press releases have confirmed that they understand that, if they want to continue to insure the majority of Americans, they must abandon their current business model and come to the table with policies that work. Policies that work means that everyone must be included, and that risk must be distributed in an equitable manner, based on ability to pay.
So what is their current business model that no longer works? They have been successful in limiting their exposure to the very large numbers of us who are relatively healthful: the healthy workforce, their young healthy families, and the healthy sector of the individual insurance market. But health care costs are now so high that the premiums that must be charged for these healthy risk pools are no longer affordable for the majority of us.
The industry’s response was to reduce benefits thereby reducing the upward pressure on premiums, but that has resulted in the rapidly growing epidemic of underinsurance. As a result, health care is now often unaffordable even for those who do have insurance. Also, in response to high premiums and mediocre coverage the numbers of uninsured continue to rise.
The private insurance industry has been trying to ride this out, but no more. Their hand is being forced by the political tidal wave that is sweeping over our health care system with the demand for reform that works for all of us.
They understand that in a truly universal system they must guarantee coverage for everyone regardless of preexisting conditions. Since that would push premiums up, they know that they must add larger numbers of healthy individuals to dilute the risk in their pools. An obvious source is the large numbers of young, healthy individuals who are uninsured. But the only way those individuals would pay the high premiums would be by forcing them to participate. Thus an individual mandate must be coupled with guaranteed issue.
The industry pretends that an individual mandate with guaranteed issue is all that they need to be major players, but they are reticent on revealing the most crucial barrier that they face. Although premiums for private plans are already too high for average-income individuals to afford, they must reverse the innovations that have led to underinsurance. Obviously that will significantly increase premiums. Also, since they currently sell to mostly healthy individuals, adding those with preexisting disorders will result in even higher premiums.
What to do, what to do? The AHIP release gives us a couple of hints.
Those supporting universal coverage through private health plans have long conceded that tax credits (or vouchers) must be used to assist low-income individuals with the purchase of their plans. In their press release, AHIP now states that we must use “refundable, advanceable tax credits for moderate-income individuals and working families.” Finally, the industry explicitly concedes that most of us can no longer afford to purchase their health plans. So who is going to help? The taxpayers. Gee, isn’t that us?
The other problem is how are they going to pay for the high-risk individuals who now must be covered? Their solution is somewhat more cryptic. They are going to “ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.” “Premium stability” means that other sources will be paying the higher costs of the higher-risk individuals. What other sources? They propose “Guarantee Access Plans” which are “loosely modeled on state high-risk pools.” Oops. The taxpayers – us – again.
Think about it. The private insurance industry has just the solution for us, but only if we agree to foot the bill for those who actually need health care, while they continue to collect large premiums to pay for their egregiously wasteful administrative excesses.
Their proposal is to shift the real costs of health care to the taxpayer. They are right. We need to establish a universal risk pool and fund it equitably based on ability to pay. The only sensible way to do that is through a single payer national health program. Why would we want to implant on our health care financing system the cancer of private health plans?

AHIP & BCBSA support guaranteed issue and individual mandate

Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate

AHIP (America’s Health Insurance Plans)
November 19, 2008

Summary of AHIP’s Proposal to Guarantee Coverage for Pre-existing Conditions and Promote Affordability in the Individual Insurance Market:

* Guarantee-issue coverage with no pre-existing condition exclusions;

* Establish an individual coverage requirement with an insurance coverage verification system, an automatic enrollment process and effective enforcement of the requirement that all individuals purchase and maintain coverage;

* Promote affordability by: providing refundable, advanceable tax credits for moderate-income individuals and working families; and promoting tax equity whether coverage is obtained through an employer or the individual market; and

* Ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.

http://www.ahip.org/content/pressrelease.aspx?docid=25068

And…

BCBSA Announces Support for Individual Mandate Coupled with a Requirement for Insurers to Offer Coverage to All

BlueCross BlueShield Association (BCBSA)
November 19, 2008

To assure truly meaningful reform, the Blue Cross and Blue Shield Association (BCBSA) and the 39 member Blue Cross and Blue Shield companies today announced support for every individual being required to have coverage and all insurers being required to accept everyone regardless of their health status.

http://www.bcbs.com/news/bcbsa/bcbsa-announces-support-for.html

Comment:

By Don McCanne, MD

If anyone has any remaining doubt that comprehensive reform is close at hand, just look at the response of the private insurance industry. AHIP, representing 1,300 insurance companies, and BlueCross BlueShield Association, insuring over 100 million individuals, in simultaneous press releases have confirmed that they understand that, if they want to continue to insure the majority of Americans, they must abandon their current business model and come to the table with policies that work. Policies that work means that everyone must be included, and that risk must be distributed in an equitable manner, based on ability to pay.

So what is their current business model that no longer works? They have been successful in limiting their exposure to the very large numbers of us who are relatively healthful: the healthy workforce, their young healthy families, and the healthy sector of the individual insurance market. But health care costs are now so high that the premiums that must be charged for these healthy risk pools are no longer affordable for the majority of us.

The industry’s response was to reduce benefits thereby reducing the upward pressure on premiums, but that has resulted in the rapidly growing epidemic of underinsurance. As a result, health care is now often unaffordable even for those who do have insurance. Also, in response to high premiums and mediocre coverage the numbers of uninsured continue to rise.

The private insurance industry has been trying to ride this out, but no more. Their hand is being forced by the political tidal wave that is sweeping over our health care system with the demand for reform that works for all of us.

They understand that in a truly universal system they must guarantee coverage for everyone regardless of preexisting conditions. Since that would push premiums up, they know that they must add larger numbers of healthy individuals to dilute the risk in their pools. An obvious source is the large numbers of young, healthy individuals who are uninsured. But the only way those individuals would pay the high premiums would be by forcing them to participate. Thus an individual mandate must be coupled with guaranteed issue.

The industry pretends that an individual mandate with guaranteed issue is all that they need to be major players, but they are reticent on revealing the most crucial barrier that they face. Although premiums for private plans are already too high for average-income individuals to afford, they must reverse the innovations that have led to underinsurance. Obviously that will significantly increase premiums. Also, since they currently sell to mostly healthy individuals, adding those with preexisting disorders will result in even higher premiums.

What to do, what to do? The AHIP release gives us a couple of hints.

Those supporting universal coverage through private health plans have long conceded that tax credits (or vouchers) must be used to assist low-income individuals with the purchase of their plans. In their press release, AHIP now states that we must use “refundable, advanceable tax credits for moderate-income individuals and working families.” Finally, the industry explicitly concedes that most of us can no longer afford to purchase their health plans. So who is going to help? The taxpayers. Gee, isn’t that us?

The other problem is how are they going to pay for the high-risk individuals who now must be covered? Their solution is somewhat more cryptic. They are going to “ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.” “Premium stability” means that other sources will be paying the higher costs of the higher-risk individuals. What other sources? They propose “Guarantee Access Plans” which are “loosely modeled on state high-risk pools.” Oops. The taxpayers – us – again.

Think about it. The private insurance industry has just the solution for us, but only if we agree to foot the bill for those who actually need health care, while they continue to collect large premiums to pay for their egregiously wasteful administrative excesses.

Their proposal is to shift the real costs of health care to the taxpayer. They are right. We need to establish a universal risk pool and fund it equitably based on ability to pay. The only sensible way to do that is through a single payer national health program. Why would we want to implant on our health care financing system the cancer of private health plans?

AHIP & BCBSA support guaranteed issue and individual mandate

Health Plans Propose Guaranteed Coverage for Pre-Existing Conditions and Individual Coverage Mandate

AHIP (America’s Health Insurance Plans)
November 19, 2008

Summary of AHIP’s Proposal to Guarantee Coverage for Pre-existing Conditions and Promote Affordability in the Individual Insurance Market:

* Guarantee-issue coverage with no pre-existing condition exclusions;

* Establish an individual coverage requirement with an insurance coverage verification system, an automatic enrollment process and effective enforcement of the requirement that all individuals purchase and maintain coverage;

* Promote affordability by: providing refundable, advanceable tax credits for moderate-income individuals and working families; and promoting tax equity whether coverage is obtained through an employer or the individual market; and

* Ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.

http://www.ahip.org/content/pressrelease.aspx?docid=25068

And…

BCBSA Announces Support for Individual Mandate Coupled with a Requirement for Insurers to Offer Coverage to All

BlueCross BlueShield Association (BCBSA)
November 19, 2008

To assure truly meaningful reform, the Blue Cross and Blue Shield Association (BCBSA) and the 39 member Blue Cross and Blue Shield companies today announced support for every individual being required to have coverage and all insurers being required to accept everyone regardless of their health status.

http://www.bcbs.com/news/bcbsa/bcbsa-announces-support-for.html

Comment:

By Don McCanne, MD

If anyone has any remaining doubt that comprehensive reform is close at hand, just look at the response of the private insurance industry. AHIP, representing 1,300 insurance companies, and BlueCross BlueShield Association, insuring over 100 million individuals, in simultaneous press releases have confirmed that they understand that, if they want to continue to insure the majority of Americans, they must abandon their current business model and come to the table with policies that work. Policies that work means that everyone must be included, and that risk must be distributed in an equitable manner, based on ability to pay.

So what is their current business model that no longer works? They have been successful in limiting their exposure to the very large numbers of us who are relatively healthful: the healthy workforce, their young healthy families, and the healthy sector of the individual insurance market. But health care costs are now so high that the premiums that must be charged for these healthy risk pools are no longer affordable for the majority of us.

The industry’s response was to reduce benefits thereby reducing the upward pressure on premiums, but that has resulted in the rapidly growing epidemic of underinsurance. As a result, health care is now often unaffordable even for those who do have insurance. Also, in response to high premiums and mediocre coverage the numbers of uninsured continue to rise.

The private insurance industry has been trying to ride this out, but no more. Their hand is being forced by the political tidal wave that is sweeping over our health care system with the demand for reform that works for all of us.

They understand that in a truly universal system they must guarantee coverage for everyone regardless of preexisting conditions. Since that would push premiums up, they know that they must add larger numbers of healthy individuals to dilute the risk in their pools. An obvious source is the large numbers of young, healthy individuals who are uninsured. But the only way those individuals would pay the high premiums would be by forcing them to participate. Thus an individual mandate must be coupled with guaranteed issue.

The industry pretends that an individual mandate with guaranteed issue is all that they need to be major players, but they are reticent on revealing the most crucial barrier that they face. Although premiums for private plans are already too high for average-income individuals to afford, they must reverse the innovations that have led to underinsurance. Obviously that will significantly increase premiums. Also, since they currently sell to mostly healthy individuals, adding those with preexisting disorders will result in even higher premiums.

What to do, what to do? The AHIP release gives us a couple of hints.

Those supporting universal coverage through private health plans have long conceded that tax credits (or vouchers) must be used to assist low-income individuals with the purchase of their plans. In their press release, AHIP now states that we must use “refundable, advanceable tax credits for moderate-income individuals and working families.” Finally, the industry explicitly concedes that most of us can no longer afford to purchase their health plans. So who is going to help? The taxpayers. Gee, isn’t that us?

The other problem is how are they going to pay for the high-risk individuals who now must be covered? Their solution is somewhat more cryptic. They are going to “ensure premium stability for those with existing coverage through a broadly funded reimbursement mechanism that spreads costs for the highest-risk individuals.” “Premium stability” means that other sources will be paying the higher costs of the higher-risk individuals. What other sources? They propose “Guarantee Access Plans” which are “loosely modeled on state high-risk pools.” Oops. The taxpayers – us – again.

Think about it. The private insurance industry has just the solution for us, but only if we agree to foot the bill for those who actually need health care, while they continue to collect large premiums to pay for their egregiously wasteful administrative excesses.

Their proposal is to shift the real costs of health care to the taxpayer. They are right. We need to establish a universal risk pool and fund it equitably based on ability to pay. The only sensible way to do that is through a single payer national health program. Why would we want to implant on our health care financing system the cancer of private health plans?