PNHP

End fringe debate over mandates – Kuttner

End fringe debate over mandates – Kuttner

Examining Clinton & Obama's Stances on... Universal Healthcare...

Amy Goodman and Juan Gonzalez interview Robert Kuttner
Democracy Now!
February 8, 2008

Amy Goodman: Let’s talk about the healthcare plans of Hillary Clinton and Barack Obama.

Robert Kuttner: …Clinton has what’s known as a mandate. She requires people to get coverage. Obama doesn’t. Clinton and some liberal commentators, like Paul Krugman, have whacked Obama for not having a mandate. I think a mandate is a very bad idea. I think the difference between universal social insurance and a mandate is that universal social insurance, like Medicare, says that, as an American or a permanent resident of the country, you get health insurance, the same way you get Social Security. A mandate takes a social problem and makes it the individual’s problem. And in the Massachusetts version of this, on the website it says “new penalties for 2008.” You get penalized if you don’t buy health insurance, even if the health insurance that’s available is not high quality and is not affordable.

The other problem with this whole approach is that you don’t get the cost efficiencies that you get from universal health insurance, because you still have all this paperwork, you still have all the profit by private insurance companies, you still have doctors being given incentives to go for the reimbursable procedures. And as a result, the cost-containment pressures hit patients. They come in the form of less care, rather than in the form of less waste.

Juan Gonzalez: …both Krugman, in his various articles, and Clinton have claimed, on the one hand, that Obama does have mandates — he has mandates for coverage of all children — so that the mandates issue is not a principled issue, it’s a tactical issue as to what you think could be approved. Your sense of that?

Robert Kuttner: My point is that a mandate, in a situation where the whole system is sick, makes that sickness the problem of the individual. Instead of putting a gun to people’s heads, typically people who can’t afford good quality insurance, and saying to them, “You must, under penalty of law, or pay a tax or pay a fine, go out and find decent insurance,” it’s so much better policy to just have insurance for everybody. Then there’s no question of a mandate.

I think it’s a very bad position for progressives to back into, because it signals that government is being coercive, rather than government being helpful. Now, we can split hairs and argue whether Obama is being principled or tactical, but I think his discomfort with the idea of a mandate is something that I applaud. I wish that both he and Clinton had gone all the way and said, let’s just to do this right and have national health insurance. I think they could have used this as a teachable moment. They could have bought public opinion around. Medicare is phenomenally popular. Medicare is national health insurance for seniors. Let’s have national health insurance for everybody.

(Clip of Clinton/Obama debate)

Amy Goodman: It’s interesting to note something Hillary Clinton says in that clip. When she mentions a single-payer system, the audience applauds and cheers, even though it’s an option rarely seriously discussed by politicians or the corporate media. And Hillary Clinton acknowledges the applause by saying, “I know a lot of people favor [it], but for many reasons [it’s] difficult to achieve.” She doesn’t explain why she thinks it’s difficult to achieve. And polls repeatedly show a majority of Americans favor it. An A.P. poll in December found nearly two-thirds of voters want universal healthcare, in which everyone’s covered in a Medicare-type program, while more than half of voters explicitly said they support single payer. But it’s the insurance companies that are against it. Robert Kuttner, can you talk about that?

Robert Kuttner: Well, one of the reasons that it’s difficult to achieve is the lack of leadership on the part of leaders like Hillary Clinton and, for that matter, Barack Obama. I mean, if you had Hillary Clinton and Barack Obama say, “You know, this is an intramural debate that we should not be having, this debate about mandates; we should do this right: we should have national health insurance,” public opinion would turn around on a dime. And instead of it being this fringe idea, all of a sudden, just because the two of them had blessed it, it would become a mainstream idea, and we would be having a debate that we should have been having all along.

http://www.democracynow.org/2008/2/8/examining_clinton_obamas_stances_on_the

Comment:

By Don McCanne, MD

Talk about incompetent framing of the health care reform debate. Clinton and Obama are engaged in a cat fight over coercing the purchase of unaffordable and inadequate private plans, versus allowing individuals to go without coverage because it is unaffordable. Neither is acceptable.

Robert Kuttner is right. We need leadership on this issue. Affordable, comprehensive health care for everyone is fundamental to the Democratic position on reform, whereas this fundamental principle is nowhere to be found in the Republican proposals.

Either party could pull it together and support a universal, comprehensive national health program. For Democrats, it would require only minor policy adjustments and a revision of the framing. Republicans would have to build an entirely new policy infrastructure.

Barack Obama has said that, if starting anew, he would support a single payer system. Hillary Clinton understands that there is considerable public support for single payer and has said that she would sign a single payer bill if it came to her desk as president. So, how about showing a little leadership? Both of you.

Estimated cost of state's health plan raises alarm

Letters to the Editor
Boston Globe
February 10, 2008

JONATHAN GRUBER suggests that a single-payer system “would cost many multiples” of the current effort to expand health insurance coverage in Massachusetts through an individual mandate (letters, Feb 1) (http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2008/02/01/recognizing_progress_in_massachusetts_health_reform) Yet at least 18 studies conducted since 1991, including two that examined single-payer plans for Massachusetts in 1998, have found that a single-payer plan could provide comprehensive coverage for everyone while costing less than is now being spent. Savings in insurance overhead and hospital and physician office billing costs would more than offset the cost of providing access to care for those who now don’t have it. Massachusetts should reconsider this cost-effective alternative to the increasingly costly approach now being attempted.

LEONARD RODBERG
New York

The writer is a research director with Physicians for a National Health Program

Prescription for change

Hoosier doctor leads drive to fix ailing health system

By Daniel Lee
The Indianapolis Star
February 9, 2008

Dr. Rob Stone was a teenager in Southern Indiana when he felt the call to become a physician.

It began during a stint as a counselor at a camp in Tell City for children with disabilities. An Ivy League education and career as a doctor followed.

Then, decades later, came a second calling: He became an agitator for changing the nation’s health-care system.


Danese Kenon / The Star

Passion for public service: Bloomington doctor Rob Stone
consults with Lori Wilbur, Bloomington, at the Volunteers in
Medicine of Monroe County clinic. Stone, co-founder of
Hoosiers for a Commonsense Health Plan, donates time to
the clinic that serves the uninsured.

Stone, an emergency room physician at Bloomington Hospital, has emerged as one of Indiana’s most outspoken advocates for making insurance accessible to all. He is co-founder and director of Hoosiers for a Commonsense Health Plan, which contends that the current system is too profit-driven, too inefficient, and leaves too many people without affordable access to health care.

HCHP — made up of doctors, nurses, social workers, patients and others — is an affiliate of the national Physicians for a National Health Program.

From its founding in September 2005, HCHP has grown from a small band of advocates to a statewide citizens group with dozens of active volunteers and an e-mail list of more than 1,500.

Stone, 55, said his motivation stems from his many years of seeing the struggles of patients needing care.

“It started dawning on me just how crazy our current system is, and the cost shifting and the crazy patchwork quilt of payer sources, just how insane the system seems to be,” Stone said. “That, coupled with watching as the ER became more and more of the safety net for the uninsured.”

Stone brings that message to Indianapolis today during a public forum titled “Understanding the Health Care Crisis: Problems and Solutions,” which runs from 9 a.m. to noon at Indianapolis First Friends, 3030 Kessler Blvd., East Drive.

One of Stone’s favorite targets is Indiana’s largest health-care insurance provider, Indianapolis-based WellPoint, a $61 billion health insurance giant that provides coverage to 35 million people in America.
“WellPoint epitomizes our system,” he said. “They’re it.”

Stone’s PowerPoint presentation lays out his case. A Medicare-type program for all is better than the current system, he says. Medicare is currently for the elderly.

One slide — with information attributed to the International Journal of Health Services in 2005 — shows Medicare overhead spending was 3.1 percent of its budget, compared with 26.5 percent for investor-owned Blue Cross and Blue Shield plans.

Another slide — with information from the Employer Health Benefits Annual Survey and Bureau of Labor Statistics — showed that from 2000 to 2006 health insurance premiums rose 87 percent while workers’ earnings rose 18 percent.

About 47 million Americans, including 750,000 Hoosiers, are without health insurance.
It’s a complex and uphill battle.

” ‘Single payer’ is not a phrase that is rolling off anyone’s lips in the presidential race, with the exception of Dennis Kucinich,” said Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a Washington, D.C.-based research group.

Many Americans, she said, tend not to be interested in what they consider a government solution to the health-care crisis. Cassil said hospitals, insurers, device makers and many doctors benefit from the current system.

But Stone does have some allies. Physicians for a National Health Program was founded by two Harvard professors of medicine, David Himmelstein and Steffie Woolhandler, and has grown to more than 14,000 members.
“They’re a very dedicated, committed group,” Cassil said.

Groups like Stone’s, while small in the number of physicians who take part, are credible advocates because they’re out on the front lines of medicine and often stand to lose income if the reforms they seek ever become reality, Cassil said.

For its part, WellPoint sees having a competitive, free-market system as key to improving the quality of care and controlling costs.

“We believe a single-payer health-care system would hinder progress in these areas by eliminating competition and restricting patient choice and could require patients to endure long wait times for care while possibly reducing the quality of health care,” WellPoint spokesman Jim Kappel said in an e-mail.

In its recent earnings report, WellPoint touted that it lowered its administrative expenses to 14.5 percent of premium revenue in 2007 from 15.7 percent in 2006 even as it added 708,000 members.

The company also pointed to flaws in other nations’ health-care systems.

“In Canada, which has a single-payer system, the average wait between a general practitioner referral and a specialty consultation at times has been longer than 17 weeks.”

Stone stands by his position. He recalls a patient who refused to seek treatment for chest pains that turned out to be a heart attack. He finally sought treatment for a second attack, only because the first attack left him disabled — but now eligible for government coverage.

The physician has scaled back his work at Bloomington Hospital to two shifts a week to devote more time to HCHP. He volunteers at a clinic for the uninsured and serves on the hospital’s board and as chief of its medical staff. He also is a partner of his physician practice, Unity Physician Group.

Stone and his wife, Karen Green Stone, who heads HCHP’s education committee, live in a home that Stone built outside Bloomington. Their home is unofficial headquarters for the state organization.

He is finding many people who are willing to listen.

“Dr. Stone put together an incredible amount of information. It was very eye-opening,” said Beth Henricks, a tax consultant and Geist-area resident who saw Stone’s presentation to a group of executives several months ago in Indianapolis. “When I see somebody who’s that passionate, that’s really appealing to me.”

Stone’s point that the United States already has a “single-payer” program in Medicare that covers millions seemed to make sense, said Henricks, whose company First Advantage has faced annual health insurance premium increases of 20 percent to 25 percent in recent years.

“Medicare works pretty well, and it’s been around for a long time, so why not pattern something after Medicare?”

Veterans are growing segment of the uninsured in America

By Dr. Rob Stone
Bloomington Herald Times
Guest Column
February 9, 2008

Recently I heard someone refer to those without health insurance as “losers.” It made my blood boil. The implication was that they had made poor choices and didn’t “deserve” health care.

Of the 47 million without health insurance in this country, about 18 percent are children. The majority of the uninsured work, many at more than one job, but either they work a job that doesn’t offer insurance, or if it is offered, they can’t afford it.

Many of them made the mistake of getting sick, and now that they have diabetes or cancer, they have a “pre-existing condition,” and cannot get coverage for any affordable price. Is it an American value to dismiss children, sick adults, and working people as “losers”?

A newly published study from Harvard in the American Journal of Public Health (Himmelstein, Woolhandler, et al, December issue) adds a new sad story to the picture — another bunch of losers — American veterans. Almost 2 million of the uninsured are veterans, along with almost 4 million of their family members, so that one in every eight uninsured is a veteran or member of a veteran’s household.

The number of uninsured vets is up 290,000 since 2000, and many are barred from VA care because of a 2003 Bush administration order that halted enrollment for most middle-income veterans.

Uninsured veterans have as much trouble getting medical care as other uninsured people; 26 percent of uninsured veterans reported that they had failed to get needed care due to costs; 31 percent had delayed care due to costs; 49 percent had not seen a doctor within the past year; and two-thirds failed to receive preventive care. And like the uninsured in general, nearly two-thirds of uninsured veterans are working.

“Since President Bush took office, the number of uninsured vets has skyrocketed, and he’s cut eligibility, barring hundreds of thousands of veterans from care. This administration has put troops in harm’s way overseas and abandoned them and their families once they got home,” said Dr. David Himmelstein, coauthor of the study and co-founder of Physicians for a National Health Program. “We need a solution that works for veterans, their families, and all Americans — single payer national health insurance.”

I went into medicine to care for the sick. Everyone who is sick has lost something, and the health care system is supposed to help. Yes, we have winners and losers in America. Anthem and the other insurance companies are making record profits, so they look like winners. Wall Street loves them. But there are too many losers, like the millions of veterans and their family members who cannot get health care. Let’s not write off the uninsured as losers — let’s figure out how to make us all winners.

I work in the emergency room, and every day I take care of people who are afraid to come to a doctor because they know they can’t pay the bill, who fear the cost as much as they fear the diagnosis I may give them. They have lost something. Most have lost piece of mind. Many have lost dignity. Some have lost hope. It’s disgraceful that some would rather write them off as losers, and turn away.

It’s a matter of values. As Americans, we take care of each other. We take care of the young, the elderly, and the sick. We should take care of veterans. We should take care of everyone. Let’s work together to get health care for all.

This guest column was written by Rob Stone, a Bloomington physician.

Hey, candidates: selling insurance no health plan

By Rose DeMoro
Guest Column
Waco Tribune
Sunday, February 10, 2008

With the presidential contest closing in on Texas, voters may well wonder how to distinguish among the various candidates on health care, which — at least on the Democratic side — has been one of the hottest issues of debate.

The central difference is on the role of insurance. Why does this matter?

Listen to Lyle Schiele of Dallas.

“As an owner/operator in the trucking industry, I was contracted to a major trucking company. I purchased my health insurance at what was to me an enormous monthly cost of $760 through that company.

“In February ’06 I had some minor chest pains. Doctors found clogged coronary arteries and treated them with stents in two locations. As a result of this diagnosis and treatment, I was medically disqualified from trucking for 90 days. As a contractor, I wasn’t covered by COBRA and therefore lost my health insurance.

“After returning to trucking as an owner/operator and applying with several different insurance companies, I found none would sell me any. Recently, as a matter of necessity, I sold my truck and went to work as a driver with a company, primarily for the health insurance benefit.

“I was not looking for a handout. I don’t mind paying my own way. But I am no longer given that opportunity. The ‘American Dream’ of owning and operating one’s own business and success based on one’s ability and performance has been taken away. Because of the health insurance issue I can no longer operate as an independent again.”

Lyle is one of hundreds who responded to a California Nurses Association/National Nurses Organizing Committee ad describing the disparity of care available to Vice President Cheney and members of Congress and the rest of us (www.cheneycare.org).

His story is not unique. One in six insured adults has substantial problems paying medical bills, one report noted last year, and 42 percent told Zogby-UPI pollsters that their insurer had refused to pay a medical bill.

Yet, selling us more insurance — without ending insurance industry price gouging or the callous, all too routine denials of care — is at the heart of the leading candidates’ proposals in both parties.

Republicans mainly emphasize tax incentives and further unleashing a market that has already ushered in an 87 percent increase in insurance premiums alone the past decade, not counting the co-pays, deductibles and other staggering costs.

Top Democrats favor a more comprehensive approach with expanded public programs for children and the poor. But only Sen. Hillary Clinton is pushing an “individual mandate,” the requirement for everyone to buy insurance with no meaningful controls on its cost or assurances that you won’t be denied care when you need it.

Sen. Barack Obama says people don’t have insurance not because they don’t want it, “but because they can’t afford it.” He has a point.

A Kaiser Family Foundation 2007 survey found that family premiums now average $12,106 — not including all the add-ons.

Clinton’s argument that Obama is “leaving out” people by objecting to the mandate, and that requiring everyone to buy insurance constitutes “universal health care” is disingenuous.

“Having” insurance is not the same as being able to use it. You’re only being mandated to purchase the premiums; they’re not mandating the insurance companies to make sure you get the care you need.

Clinton has also criticized Obama for his past comments about a real alternative to an insurance-based system. In 2003 Obama called himself “a proponent of single-payer, universal healthcare coverage . . . everybody in, nobody out” — essentially an expanded and improved Medicare for all.

It’s a system, with some nuances, in place in every other Western country, and it works. A January, study by the London School of Hygiene and Tropical Medicine, for example, found the U.S. ranked worst among 19 industrial nations in preventable deaths.

Those results should make such a system a model for the U.S., not a campaign attack point.

What Obama says now, as he did again in a recent debate in South Carolina, is “if I were designing a system from scratch, I would set up a single-payer system.”

We are starting from scratch. Our present system has hit rock bottom, as Lyle and so many others can attest. Our families deserve no less.

Rose Ann DeMoro is executive director of the 80,000-member California Nurses Association/National Nurses Organizing Committee and a national vice president of the AFL-CIO.

AMA's Conflicted President

By Adam Doster
In These Times
February 11, 2008

Dr. Nancy Nielsen’s résumé is exhaustive. Currently a clinical professor of medicine and senior associate dean for medical education at the University of Buffalo School of Medicine and Biomedical Sciences, Nielsen has worked for the New York State Department of Health and has held various leadership positions in the American Medical Association (AMA). So it’s not surprising that the AMA voted her president-elect last June, only the second woman to hold the post. Yet other jobs on Nielsen’s résumé have alarmed some progressive healthcare advocates.

From October 2004 to July 2007, Nielsen served as chief medical officer of Independent Health Association, a Buffalo-based HMO. Although AMA spokesperson Brenda Crane notes that Nielsen ended her affiliation with Independent Health upon receiving her promotion at the AMA, her tenure raises flags for Geri Jenkins, president of the California Nurses Association, a healthcare union.

“I think you have a conflict when you have someone in that position who’s worked for an insurance company and is also a physician who’s going to run the AMA,” Jenkins says.

Since 1996, Nielsen has also sat on the board of the Medical Liability Mutual Insurance Company, one of the country’s largest medical liability carriers. While some Republicans have embraced medical malpractice reform as a virtual cure-all for America’s healthcare crisis, critics contend that putting caps on non-economic damages provides unjustified protections for hospitals, HMOs and insurance companies, another potential conflict of interest.

In a vacuum, Nielsen’s professional relationships might be considered inconsequential. But the AMA has a long history of thwarting progressive healthcare reform, which amplifies the importance of her connection to the insurance industry.

As early as the 1930s, then-AMA President Dr. Morris Fishbein wrote that a national healthcare program would cause “a weakening of national caliber,” and signal “a definite step toward either communism or totalitarianism.” When, in 1948, President Harry Truman called for the creation of a government-run national health insurance fund, the AMA characterized the bill as “socialized medicine” and campaigned against it.

Next came the 1961 battle over Medicare that pitted the Kennedy administration against a recently hired General Electric public-relations flak named Ronald Reagan. The future president recorded an LP titled “Ronald Reagan Speaks Out Against Socialized Medicine” that the AMA distributed to housewives across the country. “Operation Coffee Cup” architects suggested that women organize small gatherings, brew some java and listen to the dangers that a national healthcare system would invariably pose.

During the Clinton years, the AMA was active in the coalition that beat back “Hillarycare”–the Democrats’ last attempt at major healthcare reform.

In August, the AMA launched a $15 million advertising campaign that focused on the problems of the uninsured, hoping to persuade voters to cast their ballots in 2008 with the issue in mind. But this project has frustrated reformers, who contend that the organization’s approach to achieving universal care–providing tax breaks and vouchers for those lacking coverage so they can purchase affordable plans–is too timid.

“At best … the AMA is advocating a completely unproven method of achieving their ends and ignoring things that we know will work,” says Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program.

Given these realities, many doctors are turning their backs on the AMA. The medical news service MedPage Today estimated that the AMA represented only 15 percent of practicing U.S. physicians in 2005, down from 70 percent during the 1961 Medicare fight.

“A lot of younger doctors,” says Jenkins, “have gone into other groups and organizations because they haven’t always been happy with how the AMA is run and what they do.”

States like Minnesota and Massachusetts show majority support among physicians for a single-payer system, and the American College of Physicians–America’s second-largest physician group–endorsed such a proposal in December.

That’s made no difference to the AMA.

“The AMA has stuck with this position of vehemently opposing national health insurance,” says Woolhandler, “despite a major shift in the physician community in terms of opinion.”

With Nielsen at the helm, the AMA’s intransigence seems likely to continue.

Universal health care: U.S. could outdo Canadians

By Elizabeth Kurczynski and Allen Chauvenet
West Virginia Gazette
February 10, 2008

As physicians who treat children with blood diseases and cancer at Women and Children’s Hospital, we frequently see families with either inadequate insurance coverage or no coverage at all. These are almost always working families with one or both parents who have a steady job.

These families are part of the 47 million Americans and the 322,000 in West Virginia with no health insurance coverage. Even families with “good” coverage are paying more per year with much higher co-payments and deductibles, since the cost of health insurance for a family is now over $12,000 per year.

Most Americans realize that our health-care system is in crisis. All of the presidential candidates propose incremental changes that would offer more people the opportunity to “buy” coverage, or offer families small grants to help them buy a cheaper insurance plan that provides only adequate coverage for those who are healthy. How many can afford $12,000 a year?

Dennis Kucinich is the only candidate who favors a nationwide single-payer health plan, which would provide coverage for everyone for all health-care needs, including drugs. Everyone who votes should know that this plan exists. It is an affordable alternative to more insurance. It could cover everyone for no more money than the $7,500 per person per year that we are currently spending for health care in the United States.

In the past, Barack Obama has said that a single-payer plan is the best health plan, but he now says that it is not politically feasible. In other words, our elected representatives feel that the insurance and drug lobbying interests are too powerful to fight. But these are the people we elect to support our interests nationally!

Thousands of physicians and many organizations such as the American College of Physicians and The Charleston Gazette have endorsed a single-payer universal health plan. Physicians for a National Health Plan is a national group that has been working for a single-payer plan for the past 20 years (PNHP.org). We have a Mountaineer Chapter of PNHP here in Charleston. Every other Western country covers everybody. We can do it, too.

Such a system would be similar to the Canadian health system, but better funded, since the Canadians pay less than $4,000 per person for health care. A single-payer system would be supported by tax dollars – about 6 percent for businesses, and about 2 percent for individuals, less than we currently pay. But the system would be privately run, and patients could choose their own physicians and hospitals. Everything would be covered, including doctors, hospital stays, long-term care, mental health, dental and vision care and prescription drugs. Hospitals would be given a lump sum for the year, and would not have to negotiate with and bill dozens of separate insurance companies. Physicians would be paid a set amount for specific services, and would no longer have to employ billing clerks to fill out many different complex insurance forms to receive reimbursement at a reduced rate.

Administrative costs in our current health-care system are between 30 and 40 percent of our total health-care costs, whereas a single-payer plan such as Canada’s system, Medicaid, Medicare or the Veterans Administration health-care system, has only about 3 percent administrative costs. This dramatic savings would be enough to provide complete coverage for everyone in the United States.

Many polls have clearly shown that at least 65 percent of Americans want national health insurance, and over 97 percent of Canadians like their health-care system and would not want a U.S.-style system. How have we let our system get to the point where it is run by for-profit insurance companies whose goal is to deny care and to make more money for their Wall Street stockholders? Our Mountaineer chapter of Physicians for a National Health Plan would like all West Virginians to learn about a better alternative that can provide universal care, and eliminate the inequality and injustice in our current system.

Kurczynski and Chauvenet are both pediatricians and professors with WVU in Charleston.

Universal health care: Advocate discusses Pennsylvania single-payer plan

By CHRIS KELLY
The Evening Sun
02/07/2008

Imagine a world without worrying if a doctor could see you – or if you could pay the bill. A world where all Pennsylvanians can afford health care.

That’s the world discussed Wednesday night by Chuck Pennachio at Gettysburg Area Democracy for America’s meeting.

Pennachio, the executive director of Healthcare for All Pennsylvania and a former candidate for U.S. Senate, told the group the effort to bring universal health care to all Americans started decades ago with former President Harry Truman. He says it would have made America better. A similar plan was proposed by presidential hopeful U.S. Sen. Hillary Clinton in the early 1990s. Pennachio told the group that gathered in a room inside Valentine Hall at the Lutheran Theological Seminary that two health-care-reform plans – collectively dubbed the Family and Business Health Care Security Act – are making their way through the state Legislature as Senate Bill 300 and House Bill 1660.

The act would replace the existing health-insurance system, which typically

grants coverage through a person’s employer, with a government-run system known as single-payer universal health care. Single-payer health care would be paid for with existing state and federal funds, a 10-percent payroll contribution from all employers and a 3-percent personal income tax. The money would be paid into the Pennsylvania Health Trust and be used exclusively for health care, Pennachio said.

“I’m very intrigued by (the act),” said Elaine Jones, chairwoman for the Gettysburg Area Democracy for America, a self-described a grassroots network looking to re-establish democratic values. “I think it should be debated in Pennsylvania and I think it could be a wonderful solution,” Jones said.

If approved by the Legislature and Gov. Ed Rendell, the plan would result in a huge savings for most individuals and employers.

“Although that does sound like much, we are paying at least double that for health care now,” Pennachio said.

Savings would result from the elimination of for-profit and growth-driven insurance companies that tack on extra payments, Pennachio said. It would reduce the cost of billing and collection and do away with managed-care systems that dictate which doctors patients can see, he said.

“Employees would be able to go to a different job if they wanted,” Pennachio said. “There would be no scare of not being able to afford health coverage.”

He said the plan would eliminate the cost of private insurance plans, co-pays and deductibles.

Jones said the group was glad Pennachio provided them with more information on the act.

“The only way (health-care reform) can happen is if concerned citizens learn the facts and get their representatives to do the right thing,” she said.

The Family and Business Health Care Security Act needs 102 of 203 votes in the House, 26 of 50 in the Senate, and the governor of Pennsylvania to approve the bill in order for it to become law.

Pennachio says this is an easy bill to pass if the citizens want it. He said community members should lobby their state legislators and make them aware that that they support the bill.

Tim Macchio’s comment: Remember that the taxes would replace the existing premiums, co-pays and deductibles.

For more information, visit http://www.healthcare4allpa.org

Medical industry plans to rate payment history

By Jason Roberson
The Dallas Morning News
January 2, 2008

DALLAS – Mortgage lenders aren’t the only ones showing more interest in your credit score these days — the health industry is creating its own score to judge your ability to pay.

The new medFICO score, being designed with the help of credit industry giant Fair Isaac Corp., could debut as early as this summer in some hospitals.

Healthcare Analytics, a Waltham, Mass., health technology firm, is developing the score. It is backed by funding from Fair Isaac, of Minneapolis; Dallas-based Tenet Healthcare Corp.; and venture capital firm North Bridge Venture Partners, also based in Waltham. Each kicked in $10 million for the project he score is already raising questions from consumer advocacy groups that fear it will be checked before patients are treated. People with low medical credit scores could receive lower-quality care than those with a healthy medFICO, they argue.

“How much assurance do I have that they’re not going to look at this medFICO first, before they decide whether to treat or not?” asked Linda Foley, founder of the Identity Theft Resource Center in San Diego.

That will not happen, said Stephen Farber, chairman and chief executive of Healthcare Analytics. Hospitals will check the score, which will be based on the patient’s medical bill payment history, only after the patient is discharged, he said.

“We only come into play once the patient has been treated and discharged, and the bill already exists,” said Farber, who has visited hospital executives nationwide over the last six months to sell the concept. “We just help figure out what sort of relief a hospital should grant the patient.”

Hospitals and other caregivers already can tap into regular credit scores — even without the patient’s permission — but those are not necessarily a good indication of whether a patient will pay a medical bill, Farber said. Such credit scores are based on voluntary purchases, such as a car. Health-care debt is largely involuntary.

Under the Fair Credit Reporting Act, hospitals and doctors are allowed to report health-care debts to credit reporting agencies, but they cannot indicate what they were for.

“They have to do it in a way that there will be no way a person looking at the information would be able to guess what they were treated for,” said Frank Dorman, spokesman for the U.S. Fair Trade Commission.

Conditions concealed

By custom, hospitals generally do not report delinquent accounts, but they do turn them over to collection agencies, said Norm Magnuson, vice president of public affairs for the Consumer Data Industry Association, a Washington trade group for companies that provide credit reports.

In such cases, only the medical provider’s name and the amount owed would be listed. But even that cannot be included if the name gives away too much information, as in the Betty Ford Clinic, widely known as an alcohol and drug rehabilitation facility.

The proposed medFICO score would be legal as long as it only includes billing data. And unlike a standard report, which only lists late medical bills, the medFICO score would reflect a history of on-time payments.

To develop its scoring system, Healthcare Analytics is collecting patient billing data from hospital systems with a combined $100 billion in annual net revenue.

Tenet executives say the scoring system could help them decide whether a given patient can pay his or her bill or if they should just write it off as uncollectible, or a “bad debt” in industry lingo.

Without a way to gauge the likelihood that patients will pay their bills, hospitals cannot comfortably invest in new projects or accurately balance expenses against revenue.

Tenet, the nation’s third-largest hospital system, with 63 hospitals and medical centers, had $433 million in bad debt through this year’s third quarter. Seventy-five percent of that bad debt was from uninsured patients and 25 percent from those with deductibles they couldn’t, or wouldn’t, pay, said Steve Mooney, Tenet’s senior vice president of patient financial services.

To figure out how to collect from patients, Tenet now divides them into categories based on whether they are married or single, whether they came through the emergency room or had a scheduled procedure, and whether their regular credit score is high or low.

“But the problem with the credit score is that not everybody has one,” Mooney said. “We have about 40 percent of our self-pay patients who we do not get a credit score on.

Incorrect scoring alleged

Meanwhile, consumer advocates argue that given the problems arising from the Fair Isaac credit score — such as identity theft and inaccurate scoring data — it should not become the basis for a medical version.

In an analysis of more than 500,000 individuals’ credit scores, the Consumer Federation of America says it found that 29 percent were 50 points lower than they should have been.

“What if there’s a mis-scoring — whether it’s due to some clerical error or due to an identity theft issue, where you have two William S. Joneses who have similar numbers?” asked Foley. “This is the same problem we’ve seen in the credit industry.”

Foley said a recent personal experience heightened her sensitivity to the possible dangers.

The day before she was interviewed, she said she spent more than six hours in an emergency room with her husband, who was believed to be suffering a heart attack.

“We have an HMO, but what if we didn’t have health coverage?” Foley asked. “If he had a low score, would he have gotten the same type of care that he got last night?”

Mooney, of Tenet Healthcare, said the hospital business has changed over the past 30 years to take on characteristics of the retail industry. With patients expected to pay a larger share and do more comparison shopping, they soon will be able to purchase health care much like an automobile, he said.

Pamela Dixon, executive director of the World Privacy Forum, a consumer advocacy group, isn’t impressed. “I don’t like it; I don’t like it at all. These are people’s lives we’re talking about. This isn’t some car.”

Estimated cost of state’s health plan raises alarm

Letters to the Editor
Boston Globe
February 10, 2008

JONATHAN GRUBER suggests that a single-payer system “would cost many multiples” of the current effort to expand health insurance coverage in Massachusetts through an individual mandate (letters, Feb 1) (http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2008/02/01/recognizing_progress_in_massachusetts_health_reform) Yet at least 18 studies conducted since 1991, including two that examined single-payer plans for Massachusetts in 1998, have found that a single-payer plan could provide comprehensive coverage for everyone while costing less than is now being spent. Savings in insurance overhead and hospital and physician office billing costs would more than offset the cost of providing access to care for those who now don’t have it. Massachusetts should reconsider this cost-effective alternative to the increasingly costly approach now being attempted.

LEONARD RODBERG
New York

The writer is a research director with Physicians for a National Health Program

AMA’s Conflicted President

By Adam Doster
In These Times
February 11, 2008

Dr. Nancy Nielsen’s résumé is exhaustive. Currently a clinical professor of medicine and senior associate dean for medical education at the University of Buffalo School of Medicine and Biomedical Sciences, Nielsen has worked for the New York State Department of Health and has held various leadership positions in the American Medical Association (AMA). So it’s not surprising that the AMA voted her president-elect last June, only the second woman to hold the post. Yet other jobs on Nielsen’s résumé have alarmed some progressive healthcare advocates.

From October 2004 to July 2007, Nielsen served as chief medical officer of Independent Health Association, a Buffalo-based HMO. Although AMA spokesperson Brenda Crane notes that Nielsen ended her affiliation with Independent Health upon receiving her promotion at the AMA, her tenure raises flags for Geri Jenkins, president of the California Nurses Association, a healthcare union.

“I think you have a conflict when you have someone in that position who’s worked for an insurance company and is also a physician who’s going to run the AMA,” Jenkins says.

Since 1996, Nielsen has also sat on the board of the Medical Liability Mutual Insurance Company, one of the country’s largest medical liability carriers. While some Republicans have embraced medical malpractice reform as a virtual cure-all for America’s healthcare crisis, critics contend that putting caps on non-economic damages provides unjustified protections for hospitals, HMOs and insurance companies, another potential conflict of interest.

In a vacuum, Nielsen’s professional relationships might be considered inconsequential. But the AMA has a long history of thwarting progressive healthcare reform, which amplifies the importance of her connection to the insurance industry.

As early as the 1930s, then-AMA President Dr. Morris Fishbein wrote that a national healthcare program would cause “a weakening of national caliber,” and signal “a definite step toward either communism or totalitarianism.” When, in 1948, President Harry Truman called for the creation of a government-run national health insurance fund, the AMA characterized the bill as “socialized medicine” and campaigned against it.

Next came the 1961 battle over Medicare that pitted the Kennedy administration against a recently hired General Electric public-relations flak named Ronald Reagan. The future president recorded an LP titled “Ronald Reagan Speaks Out Against Socialized Medicine” that the AMA distributed to housewives across the country. “Operation Coffee Cup” architects suggested that women organize small gatherings, brew some java and listen to the dangers that a national healthcare system would invariably pose.

During the Clinton years, the AMA was active in the coalition that beat back “Hillarycare”–the Democrats’ last attempt at major healthcare reform.

In August, the AMA launched a $15 million advertising campaign that focused on the problems of the uninsured, hoping to persuade voters to cast their ballots in 2008 with the issue in mind. But this project has frustrated reformers, who contend that the organization’s approach to achieving universal care–providing tax breaks and vouchers for those lacking coverage so they can purchase affordable plans–is too timid.

“At best … the AMA is advocating a completely unproven method of achieving their ends and ignoring things that we know will work,” says Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program.

Given these realities, many doctors are turning their backs on the AMA. The medical news service MedPage Today estimated that the AMA represented only 15 percent of practicing U.S. physicians in 2005, down from 70 percent during the 1961 Medicare fight.

“A lot of younger doctors,” says Jenkins, “have gone into other groups and organizations because they haven’t always been happy with how the AMA is run and what they do.”

States like Minnesota and Massachusetts show majority support among physicians for a single-payer system, and the American College of Physicians–America’s second-largest physician group–endorsed such a proposal in December.

That’s made no difference to the AMA.

“The AMA has stuck with this position of vehemently opposing national health insurance,” says Woolhandler, “despite a major shift in the physician community in terms of opinion.”

With Nielsen at the helm, the AMA’s intransigence seems likely to continue.

Get ready for a Blue Cross/Blue Shield retailer near you

Blue Cross and Blue Shield opens store in Pembroke Pines

By Jaclyn Giovis
South Florida Sun-Sentinel
February 7, 2008

Blue Cross and Blue Shield of Florida Inc. wants you to buy health insurance the way you might buy a cell phone.

The insurer last month opened “Florida Blue,” its first insurance store in South Florida. Situated in the new Pembroke Lakes Square shopping center in Pembroke Pines, the store allows most consumers to walk in and buy health coverage and dental and life insurance in one visit or have questions about policies answered.

Unlike most insurance offices, Florida Blue features wi-fi access, a flat-screen TV and a PlayStation for kids. The store has computer stations where customers can look up insurance information with help from an agent.

Experts say the health insurance industry is changing, becoming more complex as health-care costs rise, the number of uninsured increases, and employers decide to cut group health insurance plans or provide employees a stipend to find their own provider.

As a result, some health insurers are looking for ways to make shopping for insurance less painful for consumers and attract new business by reaching out to people without coverage, they say.

This weekend, Florida Blue will host a grand opening with free health screenings, chair massages and giveaways.

http://www.sun-sentinel.com/business/sfl-flzinsureretail0207sbfeb07,0,5323731.story

Comment:

By Don McCanne, MD

Placing the consumer in charge of his or her own health care has been touted by the supporters of consumer-directed health care as the answer to our health care cost crisis. This includes providing consumers with a choice of coverage options in the individual private insurance market.

It is not only the advocates of HSAs and high-deductible coverage that support expansion of the individual market, it is also the leading presidential candidates from both political parties. Even the Democratic candidates would expand the individual insurance market and perhaps even mandate the purchase of these products. The clear trend, which is already taking place, is to shift coverage from employer-sponsored plans to the individual market.

Obviously Blue Cross and Blue Shield of Florida recognizes this trend and is positioning itself to be a leader in the market. Retail centers seem to be a promising untapped market outlet for their products. Although this may start a new trend that may be very beneficial for the insurance industry, it does have a downside for “health care consumers.”

Health plans in the individual market provide about 30 percent lower value than do plans in the employer-sponsored group market. The administrative costs are much higher because of marketing (advertising) costs, underwriting expenses, brokers fees, plan maintenance (individual billing), high attrition rates, and other expenses related to the fact that they are selling one individual policy at a time rather than marketing a single large package to an employer.

Another problem is that reasonably comprehensive plans have become very expensive. The average employer-sponsored plan is now over $4,500 for an individual and over $12,000 for a family. Many middle-income families can no longer afford these premiums, much less premiums adjusted upward by 30 percent because of the additional costs in the individual market.

When you shop at a retail outlet, you are looking for a good deal. In insurance, that means an affordable or even a bargain-rate premium. What kind of an insurance product will you be able to buy that has premiums well below the employer-sponsored plans, plus has protection reduced by another 30 percent to make up for the higher administrative costs? Whatever it is, if you develop significant medical problems, you’ll be at high risk of joining those insured individuals who filed for bankruptcy because of medical debt. (Medical debt is a major contributor to one-half of all personal bankruptcies, and three-fourths of those with medical debt were insured at the onset of their financial problems.)

Oh wait. What about the high overhead costs of operating a retail center? Subtract those costs as well from the benefits that your plan would cover. Whatever coverage you have left, don’t expect it to pay your medical bills.