Click here to listen to PNHPās Senior Health Policy Fellow Dr. Don McCanne on KPFKās Morning Review discussing single-payer national health insurance and the health care reform plans of the leading Presidential candidates. (Run time: 15m 51s | 14.5Mb | Mp3)
Genentech bumps $40 drug with $2000 version
U.S. senator chides Genentech plan
By David Morrill
Contra Costa Times
November 29, 2007
A U.S. senator said Genentech’s plan to restrict availability of its Avastin drug so doctors might be forced to use the more expensive medicine Lucentis to treat an eye disease will cost taxpayers $1 billion to $3 billion annually.
The South San Francisco-based biotech company’s decision “is of great concern to me,” U.S. Sen. Herb Kohl, D-Wis., said in letters to the U.S. Centers for Medicare and Medicaid Services and the Food and Drug Administration made public Wednesday.
Avastin is one of Genentech’s blockbuster cancer drugs. It treats patients with colon and lung cancer and is being studied worldwide in about 300 clinical trials for more than 20 tumor types.
But Avastin is also in the offices of eye doctors across the country, where it is being used to treat a major cause of vision loss, called neovascular age-related macular degeneration, or AMD.
The company’s superstar drug is going head-to-head with a drug called Lucentis that was approved last year by the U.S. Food and Drug Administration for AMD. Lucentis is also owned by Genentech.
The quandary is more than just two drugs that could potentially be used to fight the same eye disease. Lucentis costs about $2,000 per monthly dosage; Avastin could cost about $40.
Although it’s not stopping the off-label use of Avastin, Genentech did announce in October a move that some fear will make it harder for physicians to prescribe the medication.
Physicians need the help of specialized groups, called compounding pharmacies, to break down initial allotments of Avastin. The amount of the drug needed for eye injections is much smaller than what is required to treat cancer.
Genentech announced that as of January, these specialized pharmacies will no longer be able to purchase the product from wholesale distributors.
Some have asked Genentech to conduct a study comparing the effectiveness of Lucentis and Avastin in treating AMD, but the company has no plans to do so.
“For Genentech, we think our resources would be better spent to continue to do research in unmet patient needs,” said Krysta Pellegrino, spokeswoman for Genentech. “We believe that we’ve already shown that Lucentis is the right treatment for this eye disease.”
http://www.contracostatimes.com/news/ci_7588959?nclick_check=1
For more on this controversy:
http://www.allaboutvision.com/conditions/lucentis-vs-avastin.htm
Comment:
By Don McCanne, MD
Isn’t the marketplace beautiful?
Genentech found that the primary competition for its $2000 drug (Lucentis brand of ranibizumab) was its own expensive product for colon and lung cancer (Avastin brand of bevacizumab).
The pricing of drugs is not based simply on their development and production costs but rather is based more on what the market will bear. The ability of compounding pharmacists to greatly dilute the dose of Avastin to levels appropriate for treatment of the retina resulted in a plummeting of the price per dose compared to that of Lucentis.
As any successful business would do, Genentech made a decision to destroy its own competition with itself by prohibiting the legal sale of Avastin to the compounding pharmacists.
Since markets always result in lower costs through price competition, we certainly would not want the government to interfere through regulatory oversight. But since Genentech does not actually compete with itself it is able to set the highest prices attainable. And it is certainly understandable that Genentech does not want to do a head-to-head comparison study between its $2000 drug and its $40 drug.
The good news is that “U.S. government funds will be used to compare effectiveness and safety of the two different treatments. National Eye Institute (NEI) officials announced in October 2006 that they will launch their own clinical trials comparing outcomes of both Lucentis and Avastin as macular degeneration treatments.” (See allaboutvision link above.)
The likely bad news will be that, once again, our tax dollars will fund the research for private industry, and, if Avastin passes muster, Genentech will surely release it as a product specifically reformulated for retinal use, at a bargain price of $1900 per dose.
Isn’t our uniquely American health care system great?
Medicare out-of-pocket spending
How Much 'Skin In The Game' Do Medicare Beneficiaries Have? The Increasing Financial Burden Of Health Care Spending, 1997--2003
By Patricia Neuman, Juliette Cubanski, Katherine A. Desmond and Thomas H. Rice
Health Affairs
November/December 2007
Rising health costs and an aging population present critical policy challenges. This paper examines the financial burden of out-of-pocket health spending among Medicare beneficiaries between 1997 and 2003. Over this period, median out-of-pocket spending as a share of income increased from 11.9 percent to 15.5 percent. In 2003, the 25 percent of beneficiaries with the largest burden spent at least 29.9 percent of their income on health care, while 39.9 percent spent more than a fifth of their income on health care. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries.
http://content.healthaffairs.org/cgi/content/full/26/6/1692
Comment:
By Don McCanne, MD
Hmmm. Most of us are grateful that our seniors have Medicare coverage so that they don’t have to face financial hardship in the event of medical need. But is that assumption valid?
About 40 percent of Medicare beneficiaries spend more than 20 percent of their incomes on health care. For most of them that does constitute a financial hardship that is severe enough such that some will decline beneficial health care services simply because they can’t afford to pay for them.
Advocates of consumer-directed health care support increasing sensitivity to health care costs through higher premiums, deductibles, copayments, coinsurance, donut holes and whatever other patient cost-sharing techniques that can be devised. But Medicare beneficiaries don’t need more lessons on the high costs of their health care. What they need is more affordable access to that care.
Providing financial disincentives to receiving beneficial health care services and products is the exact opposite of what our Medicare policies should be.
Do the nonelderly have a similar problem with a high percentage of out-of-pocket spending on health care? Since most seniors have lower incomes composed of social security benefits and retirement accounts, it would be expected that the out-of-pocket spending on health care would be higher as a percentage of total income for them than it would be for the nonelderly who have higher salaries and wages. And that is true.
Although about 40 percent of Medicare beneficiaries spend more than 20 percent of their incomes on health care, only 7.3 percent of nonelderly adults do likewise.
Wait a minute. 7.3 percent of nonelderly adults spend more than 20 percent of their incomes on health care? That’s close to 20 million people. And for a large percentage of them, having to spend over 20 percent of their incomes on health care does constitute a financial hardship.
Most other nations provide comprehensive health care to everyone at a much lower cost without the need to burden patients with excessive cost sharing. With what we are already spending on health care, certainly we could do as well.
Our health care dollars at work
Blue Cross CEO collects $16.4 million
By Susanne L. King
Berkshire Eagle
Wednesday, November 28
For all you boomers who are looking retirement in the eye, cast your gaze on a recent Boston Globe article entitled “Blue Cross gave chairman $16.4 million in retirement pay.” William C. Van Faasen, 58, collected those benefits in 2006, even though he didn’t leave the company. He merely stepped down as chief executive of Blue Cross and Blue Shield of Massachusetts, but retained his position as chairman, receiving nearly $3 million in salary and bonuses the same year he collected retirement benefits. This astonishing gift went to the chairman of a non-profit organization that does not pay income taxes to a state that is trying to provide universal health insurance to its citizens.
According to a survey conducted by the non-partisan research group, the Employee Benefit Research Institute, the rising costs of health care are cutting into the ability of workers to contribute to their retirement accounts. The researchers found that 63 percent of Americans have experienced an increase in costs they had to pay under their health plans in the past year. Of those, more than 50 percent reduced their household savings because of increased health care costs, and 30 percent decreased the amount they saved they saved for retirement.
On the other hand, Van Faasen retires at an early age, wealthy beyond one’s wildest dreams thanks to our health care dollars. And we work longer and find it harder to fund our retirement years.
Massachusetts, meanwhile, is having trouble finding enough money for its new health care program, as more previously uninsured people have signed up for the government-subsidized health plans than was anticipated. The Berkshire Eagle reported last week that the state may need an additional $146 million to pay for the program this fiscal year.
In a separate article, The Eagle also reported that insurance companies estimated that prices for the Commonwealth Choice health plans that are not subsidized by the state will be raised 10-12 percent by the insurance companies next year. In addition, the cheapest and most heavily subscribed plan will be dropped. The lack of affordability of the insurance plans for the state, individuals, and businesses makes Van Faasen’s salary and retirement benefit package, and Blue Cross /Blue Shield’s non-profit status, even more astonishing.
If we had a single-payer health insurance program, either in our state or nationwide, insurance companies, with their bloated administrative expenses that include CEO salaries and retirement benefits, would not exist. Health care funds would be administered by either the state or federal government, and administrative expenses would be 3 percent instead of more than 30 percent. Nationally, this would save $350 billion annually in administrative costs, enough to provide comprehensive health care for the 47 million uninsured people in our country. Everyone would be in the same risk pool, and cherry-picking of healthy workers by the insurance companies would not exist. There would be no drain of our hard-earned retirement funds to line the pockets of health insurance company executives.
Single-payer legislation in our state is called the Massachusetts Health Care Trust, Senate Bill 703 (full text at www.mass.gov/legis/bills/senate/185/st00/st00703.htm).
The federal legislation for single-payer health care is H.R. 766. You might be interested in the covered services in the state single-payer bill, in order to compare them to your current Massachusetts health insurance coverage. The benefits in the single-payer bill include prevention, diagnosis and treatment of illness and injury, both inpatient and outpatient, as well as mental health and dental care, acupuncture, physical therapy, chiropractic and podiatric treatment. Covered benefits also include all prenatal and maternity care, rehabilitation of sick and disabled persons, prescription drugs, and medical equipment and appliances-all the services that you would expect in a comprehensive health plan.
Of especial interest to all you baby boomers (and your children), other covered benefits are home health care, including personal care, and long-term care in nursing homes. The legislation specifically states: “No deductibles, co-payments, co-insurance, or other cost sharing shall be imposed with respect to covered benefits.” Now that would improve your retirement planning — no need to buy long-term care insurance and health insurance policies to supplement Medicare and pay for your prescriptions. If we did not have to fill the coffers of the insurance companies and their executives, we would all be better off financially.
Health insurance companies have money and powerful lobbying forces; you have your voice. Call, write or e-mail your legislators and tell them what you think.
Susanne L. King, M.D. is a Lenox practitioner.
Dr. Bret McFarlin to Question Candidates During Heartland Presidential Forum in Des Moines Iowa on Saturday, December 1, 2007
Des Moines (November 27, 2007)–On Saturday, December 1, Dr Bret McFarlin representing Iowa Citizens for Community Improvement will take part in the Heartland Presidential Forum in Des Moines, Iowa by asking a presidential candidate a question regarding healthcare reform. Candidates participating in the forum are Sen. Hillary Clinton, Sen. John Edwards, Sen. Christopher Dodd, Congressman Dennis Kucinich and Sen. Barack Obama. The entire forum, which is sponsored by the Center for Community Change (CCC) and Iowa Citizens for Community Improvement (CCI), will live on C-SPAN at 2:00 PM Central time.
The Heartland Presidential Forum, which is expected to draw 5,000 attendees, differs from other forums with its unique format. Top-tier candidates will take their turn onstage and will be asked real questions by real people, rather than giving canned speeches. This design is meant to put power back in the hands of the people and hold candidates accountable to what we the people really value.
Dr McFarlin points out that, “Universal health insurance reform is a high priority domestic issue this caucus season. As ever increasing number of Americans find healthcare inaccessible or unaffordable, our social solidarity and shared commitment to the greater good is called into question.”
The forum is an important part of the Campaign for Community Values, a multi-issue and multi-year effort to challenge the divisive message of the right and to promote Community Values. The Campaign for Community Values is a collective by more then 100 community-based organizations from all over the country to have an impact on public opinion and the 2008 elections.
Dr. McFarlin is Director of Internal Medicine at Broadlawns Medical Center, Polk County’s safety net hospital, a member of Physicians for a National Health Program, and an advocate for universal healthcare reform.
Visit www.iowaheartlandforum.org for more information on forum.
###
SiCKO Cure Road Show Rolls into New Orleans, Joins Voices Calling for Charity Hospital Reopening
By Donna Smith
Progressive Democrats of America, Colorado member
November 27, 2007, New Orleans, LA
The SiCKO Cure Road Show rolled into New Orleans on Saturday, and the road show team immediately joined a meeting of local activists fighting the demolition of thousands of public housing units. Though some relatively powerful groups oppose the loss of some 3,900 public housing units, the demolitions will begin on December 4 unless an unexpected court ruling or an even more unlikely change of heart occurs to halt the tearing down of this vital housing for low income residents of the area.
Many people believe that the rebuilding of New Orleans includes a significant shifting of resources and effort toward private ownership and operation of formerly public facilities and services. Charity Hospital, which, prior to Katrina, provided vital health care and out-patient services to more than 500,000 people annually has never reopened. If those displaced by Katrina are ever to return to their homes in New Orleans, and if the city is ever to rebuild the full richness of its character and its people, the gutting of those places and services that allow societal diversity-race, class and otherwise-must be halted.
The road show has the mission of bringing the message of HR676, single-payer universal health care (The National Health Insurance Act), to the people of the area, and the issues of homelessness and lack of public facilities serving the poor and uninsured often go hand-in-hand with a lack of access to health care and other issues surrounding poverty. Donna Smith, who appears in ‘SiCKO,’ is on the road show team, and it also includes Liv Boykins, special assistant to Rep. John Conyers of Michigan, Julia Atkins of Florida, Joe Friendly of New York City and Bill Hill of Tucson. The team pulled into New Orleans after visiting cities in Indiana, Kentucky, Tennessee, Alabama and Mississippi.
More than two years ago, Hurricane Katrina and the levy breaches that followed claimed the lives of thousands in New Orleans as a horrified world watched. Though the FEMA debacle and the ‘Heckuva job Brownie’ moments made us all ashamed of the U.S. government’s response to the disaster, the continued failure of the local, state and federal government responses now cry out for more than shame and outrage-and most especially for action.
Brad Ott of New Orleans leads The Committee for the Reopening of Charity Hospital, and he explained after the viewing of SiCKO on Saturday evening at the Ashe’ Cultural Arts Center that one of the group’s efforts will be to bring a class action legal case on behalf of those who now find themselves unable to access health care and who were formerly patients at Charity Hospital. Ott is looking for plaintiffs in the case and urges those who may be interested to contact him.
Additional efforts to stop the demolition of public housing continue as well. For more information on that effort in new Orleans, click here.
The SiCKO Cure National Road Show team pushes off for Tallahasee next, and for more information on the tour and its stops please visit healthcare-now.org. The road show is being co-sponsored by Healthcare-Now, the California Nurses Association, Physicians for a National Health Program, and other groups along the way.
Join Donna Smith and other PDA healthcare activists in the PDA Healthcare for All/Single Payer Healthcare Issue Organizing Team. Contact Diane@pdamerica.org.
Study finds immigrants' use of healthcare system lower than expected
UCLA researchers find that Latinos in the U.S. illegally are 50% less likely to visit emergency rooms.
By Mary Engel
Los Angeles Times Staff Writer
November 27, 2007
Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.
The cost of providing healthcare and other government services to illegal immigrants looms large in the national debate over immigration.
In Los Angeles County, much of the focus of that debate has been on hospital emergency rooms. Ten have closed in the last five years, citing losses from treating the uninsured, and those that remain open are notorious for backlogs.
By federal law, hospitals must treat every emergency, regardless of a person’s insurance — or immigration — status. Illegal immigrants, who often work at jobs that don’t offer health insurance, are commonly seen as driving both the closures and the crowding.
But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.
“The current policy discourse that undocumented immigrants are a burden on the public because they overuse public resources is not borne out with data, for either primary care or emergency department care,” said Alexander N. Ortega, an associate professor at UCLA’s School of Public Health and the study’s lead author. “In fact, they seem to be underutilizing the system, given their health needs.”
Ira Mehlman, media director for the Federation for American Immigration Reform, a group that lobbies for tougher immigration controls, said that usage rates are just one measure of illegal immigrants’ effect on healthcare. The other factor, he said, is the cost to taxpayers, which Ortega’s study did not examine.
Cost estimates vary widely. A Rand Corp. study published last year in the journal Health Affairs put the cost of healthcare for illegal immigrants nationwide at $1.1 billion a year, excluding care for those younger than 18 and older than 64.
FAIR called the Rand number a “low-ball” estimate. Its own study of healthcare costs of illegal immigrants and their dependents, including U.S.-born children, estimated California’s portion alone to be about $1.5 billion a year.
Mehlman said $1.5 billion “is still a significant amount of money, unless you’re Bill Gates.”
Ortega’s study is not the first to find that illegal immigrants use fewer healthcare services than people born in the U.S. But his study used the largest sample, analyzing data from 42,044 participants of the 2003 California Health Interview Survey, a randomized telephone survey conducted by the UCLA Center for Health Policy Research and the California Department of Public Health.
And while other studies have attributed lower usage to immigrants simply being younger and healthier than the overall population, the study published Monday took into account age, health status, insurance status and poverty level. All such factors being equal, it found, immigrants still made fewer visits to physicians and were 30% less likely than U.S.-born Latinos to have a regular source of healthcare.
Dr. Felix Nuñez, a Los Angeles-based family physician and former medical director of the South Central Family Health Center, said the findings confirm what he sees in clinics.
Illegal immigrants are infrequent patients for primary care visits, he said, because being asked for ID cards, Social Security numbers and employment histories makes them nervous. They fear being reported to authorities, even though the information is used only to determine Medi-Cal eligibility or to set a sliding-scale fee.
What did surprise Nuñez was the relatively low use of emergency rooms by illegal immigrants.
“My gut would have told me that they’d be higher users of emergency services because they’re not coming in for routine, preventive care,” he said. “This kind of study is really important because it forces you to look at the data and rethink your assumptions.”
Just Off Insular Senate Floor, Life of the Uninsured Intrudes
By ROBERT PEAR
The New York Times
November 25, 2007
WASHINGTON, Nov. 24 — When senators debate health care, they usually speak in abstract terms about soaring health costs and the plight of the uninsured.
But just 20 feet from the Senate chamber is a young man who knows those problems all too well from personal experience. The man, Sergio A. Olaya, runs the Capitol elevators on which the senators ride. Whenever the Senate is in session, he is on duty.
Mr. Olaya, 21, is struggling with $255,000 of medical bills incurred by his mother before she died in April from an aggressive form of brain cancer.
A local hospital and its collection agency have been hounding him in an effort to collect from his mother’s estate, Mr. Olaya said. To pay the bills, he is selling the Maryland home where he lived with his mother, Clara Ines Olaya, 61.
His experience highlights the problems of the uninsured, from which members of Congress are usually insulated. The leading Democratic presidential candidates say all Americans should have coverage as good as what Congress has.
As a government employee, Mr. Olaya has health insurance. But his mother, like 47 million other Americans, was uninsured.
“I wonder how many senators have been in the elevator with Sergio, talked to him, shared a smile with him, but had no idea of the terrible burden he and his mother were carrying,” said Senator Richard J. Durbin of Illinois, the Senate Democratic whip, who learned of Mr. Olaya’s problems from an aide.
In an interview, Mr. Olaya said: “I’m just a college kid. I don’t have financial support from anyone. Paying $255,000 for medical bills derails my ability to pay for college.”
Senators have access to a wide range of insurance options through the Federal Employees Health Benefits Program. Congress has its own “attending physician” — actually, a team of 5 doctors and 14 nurses who work in the Capitol and nearby Congressional office buildings. Lawmakers can fill prescriptions at a small pharmacy in the Capitol. For more serious problems, they can use nearby military hospitals.
But Congress is far from agreement on any comprehensive proposals to help the uninsured. Even legislation to cover children has been caught up in a furious battle with President Bush over the proper role of government in providing insurance.
Senators are not normally exposed to the fears that strike many workers as employers reduce health benefits and insurers increase premiums year after year. Annual increases of 20 percent or more are not unusual for small businesses. The National Federation of Independent Business, a lobby for small business owners, says health costs are their top concern.
Since 2000, the number of uninsured, as reported by the Census Bureau, has increased by 8.6 million, or 22 percent. Some private studies suggest that one in three Americans under the age of 65 may have been uninsured at some time in the last two years.
“The truth is, almost every family is at risk because of a fraying health care safety net,” Mr. Durbin said. “Almost all of us could be one pink slip, one election, one bad diagnosis or one serious accident away from a health and economic disaster. This affects Sergio, a member of our Senate family. It affects all families.”
One lawmaker, Senator Sherrod Brown, Democrat of Ohio, has refused to accept the health insurance available to members of Congress. He says he will not take it until all Americans have access to affordable coverage.
Former Senator John Edwards, a candidate for the Democratic presidential nomination, said, “There is no excuse for politicians in Washington having health care when America has no health care.”
Mr. Edwards has been conveying that message to Iowa voters in 30-second television commercials. On his first day in office, he said, he will “submit legislation to end coverage for the president, all members of Congress and all senior political appointees in the legislative and executive branches of government on July 20, 2009 — unless Congress has enacted universal health insurance.”
One of his rivals for the nomination, Senator Hillary Rodham Clinton of New York, said she would “give all Americans the same set of insurance options that their members of Congress have.” This, she said, could be done “without any new bureaucracy.”
Another Democratic presidential contender, Senator Barack Obama of Illinois, said that under his proposal for universal coverage, everyone would have access to “health care that is as good as the health care that I have as a member of Congress.”
While waiting for such coverage, many Americans will wrestle with debts like those facing Mr. Olaya, the Senate elevator operator. He had been a student at the University of Delaware, but said he would not return until he paid his mother’s medical bills.
His mother, an expert on health and nutrition, was born in Colombia, received a master’s degree from Stanford in 1981 and became a United States citizen in 1994. She had health insurance in most of her jobs over the last 20 years, at the Centers for Disease Control and Prevention, the United States Agency for International Development, Unicef and other organizations.
But she had been unemployed and uninsured since December.
Mrs. Olaya had applied for a new federal job. When the job offer finally came in March, her son said, she had just suffered a stroke and could not get out of bed to answer the telephone. In another month or two, she might have had health coverage through her new job. In another four years, she would have been eligible for Medicare.
“Instead,” Senator Durbin said, “she had the bad luck and bad timing to fall through one of the gaping holes in America’s unraveling health care safety net. Now her only child, her son, is paying the price.”
Study finds immigrants’ use of healthcare system lower than expected
UCLA researchers find that Latinos in the U.S. illegally are 50% less likely to visit emergency rooms.
By Mary Engel
Los Angeles Times Staff Writer
November 27, 2007
Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.
The cost of providing healthcare and other government services to illegal immigrants looms large in the national debate over immigration.
In Los Angeles County, much of the focus of that debate has been on hospital emergency rooms. Ten have closed in the last five years, citing losses from treating the uninsured, and those that remain open are notorious for backlogs.
By federal law, hospitals must treat every emergency, regardless of a person’s insurance — or immigration — status. Illegal immigrants, who often work at jobs that don’t offer health insurance, are commonly seen as driving both the closures and the crowding.
But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.
“The current policy discourse that undocumented immigrants are a burden on the public because they overuse public resources is not borne out with data, for either primary care or emergency department care,” said Alexander N. Ortega, an associate professor at UCLA’s School of Public Health and the study’s lead author. “In fact, they seem to be underutilizing the system, given their health needs.”
Ira Mehlman, media director for the Federation for American Immigration Reform, a group that lobbies for tougher immigration controls, said that usage rates are just one measure of illegal immigrants’ effect on healthcare. The other factor, he said, is the cost to taxpayers, which Ortega’s study did not examine.
Cost estimates vary widely. A Rand Corp. study published last year in the journal Health Affairs put the cost of healthcare for illegal immigrants nationwide at $1.1 billion a year, excluding care for those younger than 18 and older than 64.
FAIR called the Rand number a “low-ball” estimate. Its own study of healthcare costs of illegal immigrants and their dependents, including U.S.-born children, estimated California’s portion alone to be about $1.5 billion a year.
Mehlman said $1.5 billion “is still a significant amount of money, unless you’re Bill Gates.”
Ortega’s study is not the first to find that illegal immigrants use fewer healthcare services than people born in the U.S. But his study used the largest sample, analyzing data from 42,044 participants of the 2003 California Health Interview Survey, a randomized telephone survey conducted by the UCLA Center for Health Policy Research and the California Department of Public Health.
And while other studies have attributed lower usage to immigrants simply being younger and healthier than the overall population, the study published Monday took into account age, health status, insurance status and poverty level. All such factors being equal, it found, immigrants still made fewer visits to physicians and were 30% less likely than U.S.-born Latinos to have a regular source of healthcare.
Dr. Felix Nuñez, a Los Angeles-based family physician and former medical director of the South Central Family Health Center, said the findings confirm what he sees in clinics.
Illegal immigrants are infrequent patients for primary care visits, he said, because being asked for ID cards, Social Security numbers and employment histories makes them nervous. They fear being reported to authorities, even though the information is used only to determine Medi-Cal eligibility or to set a sliding-scale fee.
What did surprise Nuñez was the relatively low use of emergency rooms by illegal immigrants.
“My gut would have told me that they’d be higher users of emergency services because they’re not coming in for routine, preventive care,” he said. “This kind of study is really important because it forces you to look at the data and rethink your assumptions.”
Access barriers for low-income families
Insurance + Access (does not equal) Health Care: Typology of Barriers to Health Care Access for Low-Income Families
By Jennifer E. DeVoe, MD, DPhil, Alia Baez, BA, Heather Angier, BA, Lisa Krois, MPH, Christine Edlund, MSc and Patricia A. Carney, PhD
Annals of Family Medicine
November/December 2007
This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.
Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs.
In summary, obtaining and maintaining insurance was the most important theme among all families. Comparing families in all insurance groups, insurance coverage issues were more often reported by families with uninsured parents or uninsured children. Access concerns were mentioned most often among those with public health insurance, whereas privately insured families more commonly mentioned unaffordable medical costs.
http://www.annfammed.org/cgi/content/full/5/6/511
Comment:
By Don McCanne, MD
This is yet another study of coverage, access and costs for low-income families. The findings are intuitive, not to mention having been supported by many other studies.
* For families with no coverage, obtaining insurance was their greatest concern.
* For families with public insurance such as Medicaid, access to care was their greatest concern.
* For families with private insurance, unaffordable medical costs were their greatest concern.
What does this mean?
For the uninsured, the consequences are obvious. In the event of medical need, being uninsured threatens both health security and financial security.
For those covered by public insurance targeted to low-income families, chronic underfunding remains a problem because of the lack of adequate political support for welfare programs. This results in a lack of willing providers, especially for specialized services. Thus access is a problem simply because the care is not available. Community Health Centers, if accessible, provide some basic needs, but cannot ensure access to more expensive, high-tech services.
For those with private insurance, health care costs remain a barrier to care. As this report states, “there is a growing number of low- and middle-income families with private health insurance who gain access to most services, but the high deductibles and co-pays prevent them from getting necessary care.”
The last statement above should concern us all. The financial barriers erected by private plans impact not only low-income families but also middle-income families as well. Yet most of the leading proposals for reform are based on a market of these private insurance plans. Lack of affordability is already a major concern, and it will only grow worse under these proposals.
The fact that this study indicated that public insurance causes access problems should not concern us since it represents a peculiarity of an underfunded welfare program – Medicaid. Our other public insurance program – Medicare – is funded at a level that assures an adequate number of willing providers, primarily because of continuing political advocacy for a popular program that eventually serves us all.
Medicare does have one problem that Medicaid does not, and that is excessive out-of-pocket cost sharing that creates affordability problems for some beneficiaries. But a new and improved Medicare for All, a single-payer national health program, would rectify that problem. Cost sharing that creates financial barriers to care would be removed.
We can have it all: health care that is universal, accessible and affordable.
Insurance payment confusion leads to bad credit reports
Why medical debts shouldn't count
For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.
By Liz Pulliam Weston
MSN Money
November 19, 2007
The Your Money message board is littered with complaints from folks whose otherwise pristine credit was sabotaged by a medical collection. Sometimes their records were besmirched over absurdly small amounts that nonetheless had big impacts on credit scores.
Medical collections are surprisingly common, at least according to a 2003 Federal Reserve study of consumer-credit reports. Nearly one in three consumers (31%) with a credit report had at least one collection account reported, and more than half of those were medical collections.
The amounts owed weren’t substantial: 36.5% of the medical collections were for $100 or less, and 86% were for $500 or less.
Yet any collection account is considered a major negative to lenders and to the credit-scoring formulas they use. Though the impact of a collection on your scores fades over time, it will shave off points for as long as the negative mark remains on your report — typically seven years.
Your chances of having your credit ruined by a medical bill are soaring for a variety of reasons:
* More people are uninsured or underinsured.
* Medical-debt collection has become big business.
* Medical billing is a mess.
Even when a consumer is covered by insurance, confusion abounds. Doctors and hospitals often insist the consumer is ultimately responsible for the bills, saying medical providers bill insurers only as a courtesy. Yet frequently the providers have agreements with insurers and government agencies to accept discounted reimbursement as payment in full; the providers aren’t supposed to pursue patients for payment.
Meanwhile, insurers are constantly changing what’s covered and by how much, and providers move in and out of covered networks. Providers also claim some insurers deliberately drag their heels on reimbursements, adding to the chaos and uncertainty.
“Insurance companies are often contributing to the false reporting of medical debt,” said (Travis Plunkett, a spokesman for the Consumer Federation of America), as tussles over payment increasingly get turned over to collection agencies.
Comment:
By Don McCanne, MD
So you have excellent coverage. About six months ago you received medical care for what proved to be a minor problem. The care included a couple of office visits, a few laboratory tests, medical imaging, two prescriptions, and you’re fine now.
Since then you’ve received numerous statements from your insurer documenting the physician visits, laboratory tests, medical imaging facility services, radiologist’s fee for interpretation of studies, and documentation from the pharmacy benefit manager. Each statement included many numbers, but the only number that really caught your attention was the dollar amount after the statement, “You are not responsible for paying this amount.” That appeared on several of the forms, though the amount noted was confusing since it didn’t seem to fit with any of the other numbers on the page. In the meantime, you have received statements from each of the medical professionals and health care institutions involved stating that your insurance has been billed and that this is the amount due (the total, non-adjusted charge), but since no payment yet appears you decide to wait until payment is actually made by the insurer and the disallowed amount is adjusted off. Otherwise you really don’t know what you should pay.
Within the past week, you have received notices from two different collection agencies representing two of the billing entities. Since your coverage is excellent, it is clear that there is some error here. What do you do?
The first step is to take out your insurance contract to see what is covered. Check for deductibles, copayments (dollar amount), coinsurance (percentage of the charges), tiering of benefits (different coverage for different levels of products or services), capping of benefits (maximum to be paid under specific categories), amounts to be paid by a fund such as a health savings account, and any other innovative features specific to your coverage. Then check to see if each professional and institution is contracted with your insurer. Since the list you have is a few years old, be sure to obtain a current list of providers. Then determine precisely how much is to be paid by the insurer, how much is to be adjusted off, and how much you are responsible for paying. The set of numbers will likely vary depending on whether or not the professional or the institution is currently contracted. Now retrieve from your records every notice of change in benefits that you received from the insurer at each annual renewal. Go back and change the numbers based on these notices, being certain that you apply the changes in chronological order.
Okay. Now that you’ve done this, you find that you do owe the amounts for which you are responsible after payments were made to the providers and the disallowed amounts were deducted. But the amounts demanded by the collection agencies are greater than the amounts that are your responsibility.
Since obviously there is an error, you now contact the administrative staff of one of the providers that are dinging you. The staff member insists that their ledger for your account is correct and that the insurer has obviously made an error. They don’t have time to help you further and insist that you contact your insurer since that’s your responsibility anyway.
After hours of punching through automated phone systems with endless times on hold, dropped calls, referrals to other departments, you finally end up where you began, and a real person in India tells you that all of their numbers are correct. She explains that the provider apparently did not adjust off the full disallowed amount, assuming, of course, that you did pay the deductibles and coinsurance that you owed. Oh.
So you call back the provider and explain that you will send payment for the deductible and coinsurance that you owe, but you want them to adjust off the balance that was disallowed. Sorry. The account has already been turned over to the collection agency and you will have to deal with them.
The collection agency responds by stating that they have nothing to do with insurance contracts. All they have is the amount that the provider turned over to them for collection, and that is the amount that you must pay. If you want an adjustment made, you’ll have to contact the provider.
Take a break from this one, and start the process over with the other collection agency. (Repeat the last six paragraphs here.)
Enough. Just pay the whole d*** thing and consider later whether to go through the grief of trying to obtain refunds from the providers. But at least this will keep your credit report clear. Sorry. These delinquencies have already been reported by both collection agencies. You can receive a free credit report if it’s been over a year since your last request, but you’ll have to pay a fee to find out how many points were deducted from your credit score.
What is really sad is that, with what you believe to be a really great health insurance plan, and with an honest effort to comply with the rules of your plan, and in spite of considerable personal inconvenience, you can become one of the more than 15 percent of individuals who end up with an impaired credit rating merely because of the administrative complexity inflicted on us by the private insurance industry.
With a single payer national health program, you go to your health care professional, receive your tests, and then follow the treatment program that you decide on after further consultation with your healthcare professional. The bills go to the single payer; you receive a statement of services and payments only to keep the process transparent.
Why are our politicians telling us that this isn’t politically feasible? Do we really want to continue to include screwed up credit reports on our list of the perverse features of an exclusively American health care system?
Do we really want to protect the thriving big business of medical-debt collection? After all, aren’t they merely an extension of the medical insurance administrative profession that we prize so highly?
Looking for a Bright Side
Republican and Democrat promote hospital coverage for all as Catamount fails Vermonters
By Peter Freyne
Seven Days: Vermont’s Independent Voice
11/21/07
Health Care Solved? — This month, the Vermont television airwaves are full of the well-done, funny ads with the farmer saying how he’s “healthy as a horse” — just before the horse behind him keels over!
The TV ads, centerpiece of a $1.6 million marketing campaign (http://www.greenmountaincare.org), were unveiled recently at Rutland Regional Medical Center by a bipartisan contingent that included Republican Gov. Jim Douglas, Democratic House Speaker Gaye Symington and Democratic Rep. Harry Chen, M.D.
The pitch is to get uninsured Vermonters over 18 who’ve been uninsured for at least 12 months to contact Green Mountain Care and sign up for the highly touted Catamount health insurance plan. That’s the one which was agreed upon by both the Democratic leadership under the Golden Dome, who surrendered on single-payer, and the best friend the insurance industry has in Vermont: Gov. Jim Douglas.
But Cambridge, Vermont, physician and health-care-reform firebrand Dr. Deb Richter doesn’t fool easily. Yours truly asked the good doctor recently for her take on what the state’s leading politicians are touting as progress.
“The governor is right, Catamount is a very good insurance product,” answered Dr. Richter. “And it will be wonderful for the few thousand people the state can afford to subsidize. But it won’t do a thing for the tens of thousands of Vermonters who are struggling to pay for health insurance policies that have huge co-pays and deductibles and barely cover their needs,” she added. “The Catamount solution is akin to putting a high-quality Band-Aid on a wound that is getting larger by the day. It won’t solve the problem. But it will get the governor re-elected. And that is the point, isn’t it?”
Richter doesn’t mince words. And she’s part of a growing body of medical doctors across the country who also want America to join the rest of the civilized world with regard to health care. They have an increasingly active national organization called Physicians for a National Health Program (https://pnhp.org). These docs share the “radical” notion with docs in France, Britain, Spain and Canada that “health care is a human right.”
Vermont’s health-care reform “Joan of Arc” was promoting Michael Moore’s illuminating film Sicko around the state this summer and fall. The other evening she brought the flick to a student audience at the University of Vermony. Good crowd turned out — almost 400.
When it was over Richter asked, “How many of you have health insurance?”
Almost all the hands in the theater went up.
“And keep your hands up if you have health insurance for life,” she added.
All but two or three hands dropped.
“See, that’s the problem,” said Dr. Deb. “Everyone in every other industrialized nation is guaranteed health care for life.”
But the “real” shame, noted this Vermont doctor, wife and mother of a college-age kid — and who does make house calls — “is that we’re already spending enough money in total to cover every single American with comprehensive coverage, eye care, dental care, prescriptions, doctor, hospital, everything!”
The audience of tuition-laden college folk was paying very close attention.
“You have to know a couple numbers,” said Richter. “Of the total amount we’re spending in Vermont, one-third of it is for administrative costs. It has nothing to do with health care. Not with people taking your blood pressure or doing any kind of surgery. You don’t need all these people in administration.
“Put it all in one pot and there’s more than enough money,” said the good doctor. “So this whole idea that we can’t afford to cover every single person in America is bullshit, and we should call it that!”
The audience burst into applause. Who doesn’t like a doctor who talks straight? In fact, Richter’s straight talk has prompted a few to suggest the candidate-strapped Vermont Left consider her as gubernatorial material in 2008.
Richter says she’s not interested. At least not at the moment.
So if there’s more than enough money to cover everyone, why isn’t everyone covered?
“You have to wipe out the insurance industry from health care. It’s a little bit of a problem,” she said with a tinge of sarcasm.
Yes, indeed.
Only in America, eh?
When it comes to your health, the middle man comes first!
The horse may topple over in the million-dollar Catamount TV ad campaign, but Dr. Deb isn’t giving up. Richter is organizing her troops behind H.304, a bill that would at least provide some hospital coverage to all Vermonters. A foot in the door, though not in the operating room.
The bill is sponsored by Barre Town Republican Rep. Topper McFaun and former Democratic Speaker of the House Michael Obuchowski of Bellows Falls.
Interesting duo, eh?
P.S. If you haven’t seen Sicko because you think you know what it’s about, do yourself a favor this holiday season. Rent it. Buy it. Sit down and watch it. Mr. Moore’s best by far.
Only in America.