Posted by Vanessa Fuhrmans
Wall Street Journal Blog
November 18, 2008, 8:26 am

Call it the ultimate inequity in health care. A team of Harvard researchers finds that people without health insurance are about 20 times more likely to donate a liver or kidney than to receive one.

The results of the study, which appear in the current issue of International Journal of Health Services, looked at U.S. transplant patients in 2003. It found that 16.9% of organ donors had no health insurance at the time of hospitalization. But only 0.8% of transplant recipients were uninsured.

Why the stark unfairness? The study’s authors say the share of uninsured donors is roughly proportionate to the total uninsured population. But donors also tend to be younger adults, who also happen to go without coverage at higher rates than older people.

The problem is on the recipient side. If someone doesn’t have financial resources or insurance, few medical centers will consider that patient a transplant candidate, the authors say.

The study was triggered after its lead author, Andrew Herring, then a third-year medical student, cared for a 25-year-old uninsured day laborer at Cambridge Hospital in Boston in 2005. Suffering from advanced cardiomyopathy, or a severely inflamed heart, the patient could not get on a transplant list, in part because he wouldn’t have been able to pay for the expensive medications needed to support his recovery. He later died.

“What struck us was he was eligible to give but not receive an organ,” says Steffie Woolhandler, the study’s co-author who was Herring’s supervisor at the time. “Had he been in a car accident six months before, everyone would have been willing to harvest his organs.” She says she doesn’t blame doctors, who must follow explicit criteria to put patients on transplant lists, but an inequitable system.

By DIANE COCHRAN
The Billings Gazette Staff
10/20/2008

The nation’s health care system is broken, and Congress is obligated to repair it, Sen. Max Baucus told an audience in Billings on Monday.

“I think in life we only have two choices on most things – try, or do nothing, and clearly we’ve got to try to crack this nut,” Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. “Doing nothing is not an option.”

Reforming the country’s health care “hodge-podge” – it’s too fragmented to be called a system, Baucus said – will probably be the biggest problem he tackles in his Congressional career, the senator said.

“Maybe it’s a new definition of the term ‘masochism,’ but I have taken it on myself to address this challenge,” Baucus said.

The United States spends more on health care than does any other industrialized nation, but Americans are not healthier than people in other countries. In fact, we’re significantly less healthy.

And the costs associated with U.S. health care are rapidly rising.

In Montana, health insurance premiums increased at more than five times the rate of wages between 2000 and 2007, according to Baucus’ statistics.

Premiums rose almost 90 percent in that time, he said.

Everything should be on the table as lawmakers consider ways to improve health care, Baucus said.

That includes making health insurance a requirement for all Americans and implementing a single-payer system, although Baucus said he didn’t think the single-payer option was realistic.

Ted Cross, a retired small-business owner, told Baucus that health care needs to be simplified.

Cross said he was charged different amounts for two identical medical treatments at the same doctor’s office, and he couldn’t figure out why. When consumers can’t decipher their medical bills, they can’t tell if they’re being overcharged, he said.

“The complexity reminds me of derivatives in the mortgage industry, and we know what’s going on there,” Cross said.

Because it is complicated and disjointed, the health care system can be difficult for senior citizens to access, said Dr. Pat Coon, a gerontologist at Billings Clinic.

“There is a spectrum of services available to them, but the ability to attain them is often fragmented,” Coon said. “Rather than staying at home where they’d prefer to live, they’re forced to move into long-term care facilities.”

There are programs in place to help some people navigate the system, but not everyone qualifies for those programs, she said.

That means some people get better access than others, and physicians sometimes have to decide who gets it, Coon said.

Sue Bailey, program manager for the Yellowstone County Council on Aging Resource Center, urged Baucus to find a way to rein in skyrocketing medical costs.

If price increases continue to outpace inflation, even people who save for long-term care or future medical problems will have trouble paying their bills, Bailey said.

“Almost everyone, if they live long enough, is going to outlive their money,” she said.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.

Ithaca Journal

Citing the claim that a single-payer health program for the United States could realize administrative cost savings of more than $300 billion annually, the writer of the Oct. 25 letter “Too good to be true?” asks: “Can someone tell us how this enormous number was derived? What are the assumptions made in the calculation? Who did the calculation?”

The $300 billion figure is a conservative estimate derived from thorough analysis of health expenditures in the United States and Canada.

In the U.S., where private health insurance companies dominate the payment system, of every dollar, 31 cents goes to administrative expenses and 69 cents to actual health care. In Canada, where there is a single-payer national health insurance program, administration accounts for 16.7 percent of health expenditures, with 83.3 percent of spending going to the care of patients. 1999 health expenditure data, found U.S. savings to be at least $294.3 billion annually.

The study, by Woolhandler, M.D., M.P.H. et al, was published in the New England Journal of Medicine in 2003. Two authors are Harvard Medical School professors. The third is with the Canadian Institute for Health Information.

A single-payer program would not only save costs but also provide comprehensive care to everyone in the United States. Evidence indicates it will also improve quality and lessen disparities.

We need more people like the writer of the letter who want to know the evidence. Discussing the evidence — regarding human, as well as financial costs — can lead to change, like single-payer, that will improve the health of the nation.

Dr. William Klepack
Dryden

Jonathan D. Walker
The Journal Gazette
November 10, 2008

America has a split personality when it comes to health care. There is recognition that the government has to provide care for the people, but there is a conflicting sense that private industry has to be involved because it can somehow be more efficient. Medicare Advantage is the upshot of this thinking — but the result has been a lot of taxpayer dollars wasted on windfall payouts to private insurance companies.

With Medicare Advantage, the government is basically paying private insurance companies more money to do what Medicare could be doing more cheaply and more efficiently in the first place — if we as citizens asked it to. A lot of this extra money is not used to help the people Medicare is supposed to be helping.

Instead, the money is wasted on administrating, marketing and generating profits for insurance companies. In other words, the government is using our tax dollars to pay for the “privilege” of bringing in all the hassles of private health insurance into Medicare.

The confusing array of plans can cause less sophisticated shoppers to get stuck with very bad plans that increase their co-pays and force them to change doctors and hospitals. Careful consumers can get what seems to be a good plan because the insurance companies can use some of the money they get from the government to offer extra benefits and services.

But even smart shoppers can get into trouble. If they get sick, they will suddenly get hit with the large deductibles that go along with these plans — often thousands of dollars. To avoid these costs, patients switch back to standard Medicare once they become ill.

This scenario turns out to be a great advantage for the private insurance companies that run the Medicare Advantage plans. They use our tax dollars to get paid to do what the government could do for less, and they make even more money by covering only the healthiest seniors.

It gets even more frustrating because the healthy seniors who are getting a great deal at taxpayer expense are understandably reluctant to modify the system (as long as they stay healthy). Whenever Congress threatens to cut back on Medicare Advantage, the insurance companies can call on these seniors to contact their representatives and halt any changes.

Multiple sources have shown that the Medicare Advantage program is a waste of money, including the Medicare Payment Advisory Commission (Congress’ advisory body on Medicare payments) and the Congressional Budget Office. According to the Government Accountability Office, Medicare Advantage plans cost taxpayers 12 percent more per recipient than standard Medicare. They estimate it will cost an extra $54 billion by 2112 — about what it would cost to provide all children in America with health insurance.

And it is not just a problem of wasted taxpayer dollars. The profit motive has resulted in terrible abuses, especially with patients who have limited abilities to understand the complexity of these plans. In a hearing in 2007, Sen. Herb Kohl, D-Wis., said, “Our investigation has revealed a disturbingly consistent picture, one which only seems to be growing. Countless seniors purchasing Medicare Advantage plans have been preyed upon and unwittingly taken advantage of by insurance agents. Seniors have been removed from traditional Medicare without their knowledge, signed onto plans they can’t afford, misled regarding coverage and told their doctors accept these plans when in reality they don’t. This is simply unacceptable.”

America’s health care system is in enough trouble without wasting resources on inefficient programs that don’t give us our money’s worth — simply because powerful lobbyists get these programs enacted and then keep the programs from being cut. When organizations like the Congressional Budget Office, the Government Accountability Office and the Medicare Payment Advisory Commission tell us that there is no advantage to Medicare Advantage, we should listen.

Jonathan D. Walker , M.D., is a member of Hoosiers for a Commonsense Health Plan. He wrote this for The Journal Gazette.