PNHP

Insurance may not be enough

Insurance may not be enough

By Dr. Susanne King
Berkshire Eagle
Wednesday, March 28

IT IS now common knowledge that 47 million people are uninsured in the United States, an increase of 5 million during the time President Bush has been in office. This health care issue is already a focus for the upcoming national election, as well as the impetus for health care reform in individual states. Massachusetts is currently implementing legislation to reduce the number of uninsured in our state, and to mandate universal health care coverage.

The plight of the underinsured is less well-known. “Underinsured” means insurance coverage is inadequate, or out-of-pocket costs are excessive. The Massachusetts Connector Board, created to implement the state health care
reform bill, has been struggling with the impossible — how to get insurance companies to offer health insurance policies that are affordable, yet also provide adequate health care coverage.

The Connector has decided that health care policies with individual medical deductibles of $2,000, and $250 prescription deductibles, meet these criteria. In the array of policies offered, there is a no-deductible plan, but patients would have to pay 35 percent of the total cost of hospitalization, x-rays, lab tests or outpatient surgery. This means that many people will be unable to afford to use their insurance, and therefore will be underinsured.

Health insurance companies have high administrative costs, which include marketing, shareholder profits, and exorbitant CEO salaries. The Springfield Republican reported this week that the CEO of Aetna received compensation in 2006 which was valued at $31 million. The reality is that insurance companies are not able to create affordable health plans. The current health care reform in Massachusetts is demonstrating just that — patients are socked with either high deductibles or high co-payments.

Meanwhile the Journal of the American Medical Association (JAMA) has published a timely study titled “Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction.” (A myocardial infarction or MI is the medical term for a “heart attack.”) The authors found that 1 in 5 patients reported they were unable to afford recommended health care after an acute MI, and that these patients had a higher prevalence of severe chest pain, a poorer quality of life, and a much greater risk of being hospitalized again.

But the most stunning finding was that two-thirds of those who reported avoiding health care services or medication because of cost, were insured. The bottom line is that high deductibles and co-payments deter people from seeking needed health care or buying medications, and this results in poorer outcomes for patients when they become ill.

The answer to underinsurance is single-payer health care, funded and administered by the state or federal government. A single-payer health care system would remove financial barriers to health care, and provide the same comprehensive care to everyone. Eliminating the insurance companies with their excessive administrative costs, would provide the funds ($300 billion) to pay for this universal comprehensive health care.

Physicians for a National Health Program (PNHP) and Healthcare-NOW are national organizations that advocate for federal legislation for single-payer health care (the bill is HR 676). During the month of April, there will be meetings across the country to support this legislation, and to educate citizens about single-payer national health care.

A meeting will be held in Lenox on April 4 at 7 p.m. at the Lenox Community Center. April has been chosen as National Healthcare Month, to advocate for HR 676 and to commemorate Rev. Martin Luther King, who said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

High Deductible Plans Penalize Women, Middle-Aged Adults, Sick Children

For Immediate Release
April 02, 2007

Contacts:
Steffie Woolhandler, M.D. 617-497-1268, 617-312-2766
David Himmelstein, M.D. 617-665-1032, 617-312-0970
Nick Skala 312-782-6006

A study by Harvard Medical School researchers finds that the increasingly popular high deductible health plans are discriminatory against women, leaving them with far higher out-of-pocket health bills than men. The researchers also found that adults 45-64, those with any chronic condition (such as asthma or high blood pressure) and children taking even one medication were likely to suffer financially in high deductible plans. The study, appearing in the July 2007 issue of the Journal of General Internal medicine, analyzed nationwide health spending data from the Medical Expenditure Panel Survey. The researchers calculated the median annual medical costs of men, women, various age groups, and of people with a variety of medical conditions. (Half of people spend more than the median and half spend less).

Under high deductible health plans, patients are responsible for at least $1,050 (often $5000) in medical bills before insurance kicks in. High deductible plans are a cornerstone of the new Massachusetts’ health reform; most of the newly-mandated, unsubsidized plans have deductibles of $2000, with co-payments and coinsurance after that. Such plans carry lower premiums than traditional coverage. Employers and politicians have touted high-deductible plans as a cost-saving strategy, hoping that they will make patients more cost conscious when they seek care. It has previously been recognized that young and healthy individuals stand to gain under high deductible policies, because few of them incur the high out-of-pocket costs.

The Harvard study is the first to show that most women will be financial losers under high deductible plans. In 2006, the median health costs for women age 18-64 was about $1000 higher than for men ($1,844 vs. $847). The difference was particularly striking among young adults (18-44), with median expenditures for women being nearly threefold higher than for men ($1,266 vs. $463). As expected, middle-aged adults had far higher expenses than did the young, making most of them financial losers in high deductible plans. For those aged 45-64, the median expenditure was $1,849 for men and $2,871 for women.

The researchers also found that most individuals with even mild chronic conditions were likely to suffer financially in high deductible plans. For the 26.9 million Americans with high blood pressure, median expenditure was $3,161. The median for the 9.7 million receiving any treatment for arthritis was $5,425, while the figure for the 5.2 million diabetics (on any medication) was $5,774. Strikingly, the 12.1 million children who took even a single prescription medication had median expenditures of $1,305.

Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and lead author of the study commented: “High deductible plans punish women for having breasts and uteruses. Our costs are higher than men’s because we need Pap tests, cervical cancer vaccine, mammograms and birth control, and because pregnancy is expensive. When employers raise deductibles, they’re giving women a pay cut. And when politicians offer tax breaks for high deductible plans, they’re discriminating against women.”

“High deductible health insurance penalizes anyone who’s sick. Even common, mild problems like arthritis and high blood pressure make you a loser in a high deductible plan. And these financial penalties keep people from getting the routine care they need to prevent disastrous illness later on”, said Dr. David U. Himmelstein, study co-author and a Harvard Medical School Associate Professor. “High deductible plans are mean spirited and unfair, and they won’t save our failing health system. We need to care for everyone and spread the costs over men and women, young and old, healthy and sick. We need better coverage, not the ever-skimpier plans that politicians are pushing. In short, we need national health insurance with first dollar coverage for all Americans.”

A copy of this study can be accessed at the following URL: https://pnhp.org/PDF_files/CDHC_Unwise.pdf

###

Physicians for a National Health Program is an organization of 14,000 physicians that support single-payer national health insurance. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact nick@pnhp.org or call 312-782-6006. www.pnhp.org.

Pew report on political values and core attitudes

Trends in Political Values and Core Attitudes: 1987-2007

The Pew Research Center
March 22, 2007

The study of the public’s political values and attitudes by the Pew Research Center for the People & the Press — the most recent in a series of such reports dating back to 1987 — finds a pattern of rising support since the mid-1990s for government action to help disadvantaged Americans. More Americans believe that the government has a responsibility to take care of people who cannot take care of themselves, and that it should help more needy people even if it means going deeper into debt.

These attitudes have undergone a major change since 1994, when the Republicans won control of Congress. In particular, 54% say the government should help more needy people, even if it adds to the nation’s debt, up from just 41% in 1994. All party groups are now more supportive of government aid to the poor, though Republicans remain much less supportive than Democrats or independents if it means adding to the deficit.

More broadly, the poll finds that money worries are rising. More than four-in-ten (44%) say they “don’t have enough money to make ends meet,” up from 35% in 2002. While a majority continues to say they are “pretty well satisfied” with their personal financial situation, that number is lower than it has been in more than a decade.

In addition, an increasing number of Americans subscribe to the sentiment “today it’s really true that the rich just get richer while the poor get poorer.” Currently, 73% concur with that sentiment, up from 65% five years ago. Growing concerns about income inequality are most apparent among affluent Americans; large percentages of lower-income people have long held this opinion.

http://people-press.org/reports/display.php3?ReportID=312

Full report (112 pages):
http://people-press.org/reports/pdf/312.pdf

Comment:

By Don McCanne, MD

This highly credible report does confirm that there has been a genuine shift in political values and core attitudes of the American public. Increasing concerns about personal financial security and about the plight of the disadvantaged add further support to the prevailing view that we have reached yet another point in history wherein comprehensive health care reform may be achievable.

However, for the public’s concerns to be translated into political action, changes will have to take place in Washington. The following quote from the report confirms that the Republicans have lost the confidence of many of the voters, but, perhaps more importantly, the Democrats have much more work to do if they expect to capture that confidence:

“Yet the Democrats’ growing advantage in party identification is tempered by the fact that the Democratic Party’s overall standing with the public is no better than it was when President Bush was first inaugurated in 2001. Instead, it is the Republican Party that has rapidly lost public support, particularly among political independents. Faced with an unpopular president who is waging an increasingly unpopular war, the proportion of Americans who hold a favorable view of the Republican Party stands at 41%, down 15 points since January 2001. But during that same period, the proportion expressing a positive view of Democrats has declined by six points, to 54%.”

N.H. House stands behind single-payer plan

By Shir Haberman
Portsmouth Herald
Thursday, March 29, 2007
shaberman@seacoastonline.com

PORTSMOUTH — The lack of federal action in finding solutions to the multitude of problems that have led to the national health care crisis has frustrated states suffering from the results of that crisis.

Nowhere is that more evident than in New Hampshire, where no less than 250 individual pieces of legislation were filed this year in an attempt to address various aspects of the problem. They range from a bill that would establish a committee to study just what is driving the cost of health care up in the state, to extending insurance coverage for the use of midwives, to establishing an electronically controlled drug prescription monitoring program.

However, the strongest indication of the bind the state finds itself in as a result of the inactivity of federal lawmakers may have been the passage of House Concurrent Resolution 5, which endorses the National Health Insurance Act put forth by Rep. John Conyers, D-Mich. The resolution passed the New Hampshire House on March 21 by almost a 2-to-1 margin.

“It’s very exciting,” said Portsmouth physician Thomas Clairmont, who was the impetus for the resolution. “It will open up the debate, because now when these (presidential candidates) come to speak before the Legislature, they will know where that body stands on health care.”

Conyers’ legislation establishes a new American national health insurance program by creating a single-payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program, aiming to expand and improve the program for all U.S. residents.

The reasons for the overwhelming New Hampshire support for Conyers’ legislation were listed in the body of the resolution. They included:

* The fact that approximately 135,000 New Hampshire citizens lacked health insurance in 2006, and those insured now often experience burdensome medical debt.

* An estimate that half of all personal bankruptcies in the state are due to illnesses or medical bills, among other issues.

State Rep. Jim Splaine, D-Portsmouth, said he and state Rep. Paul McEachern, D-Portsmouth, sponsored HCR 5 “because we wanted to make it clear that a single-payer, national health care system is what New Hampshire and the nation need.”

“There were some concerns about cost,” he said of the House State-Federal Relations and Veterans Affairs Committee, which considered the bill. “But most saw the eventual savings a single-payer system would result in.” The committee voted 9-6 to recommend passage of the resolution.

The cost of Conyers’ bill has been estimated at $1.86 trillion a year. However, it is estimated that Conyers’ plan would save more than $150 billion on paperwork alone in the first year and another $50 billion by allowing Medicare to negotiate a bulk purchasing discount for medications.

Splaine said the HCR 5 must now go to the Senate for passage. He said he is optimistic about its chances there.

As a lead-up to the visit by Illinois Sen. Barack Obama Tuesday for a “Community Meeting on Health Care,” an article on this issue will appear each day in the Portsmouth Herald. We invite readers with stories to tell to contact Shir Haberman at 570-2230 or shaberman@seacoastonline.com.

In health care reform, California needn't settle for second best

By Kay McVay, RN
San Jose Mercury News
03/29/2007

Anyone worried about the cost and availability of health care should be very wary of some of what’s being said about health care reform in California.

SB840, state Sen. Sheila Kuehl’s bill providing guaranteed health care as an expanded and improved version of Medicare for all Californians, is the gold standard reform. It’s the most comprehensive – and the only plan that controls costs by eliminating administrative waste rather than limiting care and shifting costs to families.

But, Sacramento insiders insist, SB840 is not palatable for a governor who has vetoed the bill once before.

Instead, the voices of political expediency are browbeating us to lower our standards and accept an inferior approach such as Gov. Arnold Schwarzenegger’s proposal to force Californians to buy unaffordable, substandard health plans.

Under this plan, a typical Santa Clara County family could end up spending more than $12,000, nearly one-fifth of their annual income, on insurance premiums and deductibles before their insurance company spends a dime on their medical care.

If a medical emergency occurs, out-of-pocket costs could rise to 25 percent of household income, and this minimal insurance would probably exclude such basics as dental, vision, mental health and long-term care. They would all cost extra.

There is a better path: SB840.

Since Schwarzenegger vetoed a similar proposal last year, momentum for a real solution has grown in California and across the nation.

A recent New York Times-CBS poll shows 64 percent of Americans believe the government should guarantee health insurance for all; 55 percent identified it as the top domestic priority for Congress and the president. In California, 60 percent favor a publicly funded universal health care system, like SB840 and Medicare, over the current system. The public is ahead of the politicians and policy wonks.

Schwarzenegger now says he’s for a “universal” system, although it’s cloaked in mandated, high-deductible insurance policies.

With majorities in both the Senate and Assembly, the Democrats call the shots on health care reform. It’s their decision, not the governor’s, what health care reform will pass the Legislature.

If they unite behind SB840 – which Senate President Pro Tem Don Perata in January called the “benchmark” and “ultimate solution” for our health care crisis – they have the power to make that the only plan that Schwarzenegger can sign or veto, just as they did last year.

Why should the Legislature take that step?

Premiums have jumped 87 percent in six years. SB840 is the only reform that contains costs while increasing benefits, primarily by curbing administrative waste and insurance industry profits. In California, that’s $20 billion per year.

The insurers are the principal opposition to any systemic reform. To successfully counter their elephantine influence – through the millions of dollars the insurers spend on campaign contributions – legislators need the public support generated by a guaranteed health program of quality care for all.

Would Schwarzenegger ever sign a bill detested by his insurance industry donors, who don’t want anyone interfering with their profits? A recent Datamar poll found that voters who support what the governor says he wants to accomplish also favor SB840; they want a solution that works, not a windfall for insurers.

Registered nurses are used to fighting the insurance companies for the care our patients need.

In 2004, the governor issued an emergency regulation to roll back key portions of the state’s landmark law requiring minimum safe nurse staffing levels in hospitals. The same experts who argue Schwarzenegger will never sign SB840 counseled nurses not to fight for patient safety because the governor was too popular and could not be challenged.

Instead, California’s nurses launched a spirited campaign and, with public support, ultimately persuaded Schwarzenegger to end his efforts to erode patient care standards.

There are dozens of other examples – from Social Security to women’s suffrage to ending legal segregation – that were achieved despite the perceived wisdom of the time.

Today, the public interest can prevail again. Schwarzenegger, who wants a grand accomplishment on health care for his legacy and on his re`sume` if he runs for another office, can be encouraged to sign a bill that will make all Californians proud, end our health care nightmare and set another model for the nation.

KAY MCVAY is president emeritus of the California Nurses Association. She wrote this article for the Mercury News

In health care reform, California needn’t settle for second best

By Kay McVay, RN
San Jose Mercury News
03/29/2007

Anyone worried about the cost and availability of health care should be very wary of some of what’s being said about health care reform in California.

SB840, state Sen. Sheila Kuehl’s bill providing guaranteed health care as an expanded and improved version of Medicare for all Californians, is the gold standard reform. It’s the most comprehensive – and the only plan that controls costs by eliminating administrative waste rather than limiting care and shifting costs to families.

But, Sacramento insiders insist, SB840 is not palatable for a governor who has vetoed the bill once before.

Instead, the voices of political expediency are browbeating us to lower our standards and accept an inferior approach such as Gov. Arnold Schwarzenegger’s proposal to force Californians to buy unaffordable, substandard health plans.

Under this plan, a typical Santa Clara County family could end up spending more than $12,000, nearly one-fifth of their annual income, on insurance premiums and deductibles before their insurance company spends a dime on their medical care.

If a medical emergency occurs, out-of-pocket costs could rise to 25 percent of household income, and this minimal insurance would probably exclude such basics as dental, vision, mental health and long-term care. They would all cost extra.

There is a better path: SB840.

Since Schwarzenegger vetoed a similar proposal last year, momentum for a real solution has grown in California and across the nation.

A recent New York Times-CBS poll shows 64 percent of Americans believe the government should guarantee health insurance for all; 55 percent identified it as the top domestic priority for Congress and the president. In California, 60 percent favor a publicly funded universal health care system, like SB840 and Medicare, over the current system. The public is ahead of the politicians and policy wonks.

Schwarzenegger now says he’s for a “universal” system, although it’s cloaked in mandated, high-deductible insurance policies.

With majorities in both the Senate and Assembly, the Democrats call the shots on health care reform. It’s their decision, not the governor’s, what health care reform will pass the Legislature.

If they unite behind SB840 – which Senate President Pro Tem Don Perata in January called the “benchmark” and “ultimate solution” for our health care crisis – they have the power to make that the only plan that Schwarzenegger can sign or veto, just as they did last year.

Why should the Legislature take that step?

Premiums have jumped 87 percent in six years. SB840 is the only reform that contains costs while increasing benefits, primarily by curbing administrative waste and insurance industry profits. In California, that’s $20 billion per year.

The insurers are the principal opposition to any systemic reform. To successfully counter their elephantine influence – through the millions of dollars the insurers spend on campaign contributions – legislators need the public support generated by a guaranteed health program of quality care for all.

Would Schwarzenegger ever sign a bill detested by his insurance industry donors, who don’t want anyone interfering with their profits? A recent Datamar poll found that voters who support what the governor says he wants to accomplish also favor SB840; they want a solution that works, not a windfall for insurers.

Registered nurses are used to fighting the insurance companies for the care our patients need.

In 2004, the governor issued an emergency regulation to roll back key portions of the state’s landmark law requiring minimum safe nurse staffing levels in hospitals. The same experts who argue Schwarzenegger will never sign SB840 counseled nurses not to fight for patient safety because the governor was too popular and could not be challenged.

Instead, California’s nurses launched a spirited campaign and, with public support, ultimately persuaded Schwarzenegger to end his efforts to erode patient care standards.

There are dozens of other examples – from Social Security to women’s suffrage to ending legal segregation – that were achieved despite the perceived wisdom of the time.

Today, the public interest can prevail again. Schwarzenegger, who wants a grand accomplishment on health care for his legacy and on his re`sume` if he runs for another office, can be encouraged to sign a bill that will make all Californians proud, end our health care nightmare and set another model for the nation.

KAY MCVAY is president emeritus of the California Nurses Association. She wrote this article for the Mercury News

Administrative costs of tax credits

Administrative Costs for Advance Payment of Health Coverage Tax Credits: An Initial Analysis

By Stan Dorn
The Commonwealth Fund
March 2007

New federal initiatives to cover the uninsured are under serious discussion by national policymakers and interest groups. Such initiatives include many proposals to use fully refundable federal income tax credits to subsidize uninsured individuals’ purchase of coverage. In considering the merits of his approach, policymakers can learn from the country’s only current use of tax credits to cover the uninsured–namely Health Coverage Tax Credits (HCTCs), which were created under the Trade Act of 2002. HCTCs pay 65 percent of health insurance premiums for certain workers displaced by international trade and early retirees. The credits can either be claimed after the end of the year, when annual income tax forms are filed, or advanced monthly to health insurers to help pay premiums.

This issue brief examines an aspect of the HCTC program that has received little attention in prior research: the extent to which public dollars are spent on administrative costs, rather than on health care services.

During FY 2007, an estimated 13 percent of federal funding related to HCTC advance payment will be spent for health plan administration, 21 percent will pay IRS administrative costs, and 66 percent will purchase health care. This analysis raises serious questions about the efficiency of using federal income tax credits as a strategy to subsidize health coverage for millions of uninsured Americans.

http://www.cmwf.org/usr_doc/1017_Dorn_admin_costs_advance_payment_HCTC.pdf

Comment:

By Don McCanne, MD

One of the more important objections that many of us have had to the concept of using tax credits to help with the purchase of private insurance is that it would add to the administrative burden of a system already sinking from administrative overload. This study confirms that the increased administrative costs are not merely theoretical, but are very real.

After very high start-up costs, this program of advanced payments of tax credits continued to consume 34 percent of health care spending merely for the administrative costs of the health plans and the IRS. This did not include the costs of the administrative burden of the providers of health care, and it did not include the administrative costs of other involved entities such as labor unions, community agencies, State Workforce Agencies, volunteers, and others.

Those who contend that the private sector would be more efficient might have their enthusiasm mollified by the knowledge that 91 percent of start-up costs went to private contractors. Even if it were possible to improve the efficiency of this program, it would still involve very significant administrative expenses added on to the profound administrative waste that already uniquely characterizes our system.

There is a much more efficient mechanism of making health care coverage affordable for each individual than the use of tax credits. Simply establish a universal risk pool and fund it equitably through the tax system. The marginal administrative costs would be very low since we already have a tax system, and the high administrative costs of the complex, private-insurance premium system would disappear (except perhaps for elective supplemental coverage of non-essential services).

Tax credits are only one more scheme to try to protect the private insurance industry from its demise. When it is serving us so poorly, why would we want to do that?

Plug the health care drain

Spiraling insurance premiums threaten the state’s economic security. Moving to a single-payer system – public funding, private providers – just makes sense.

By Ron Forthofer
The Rocky Mountain News
March 24, 2007

Although health care is the top domestic concern of Americans, neither the Bush administration nor congressional leaders are willing to provide the leadership necessary to solve the crises confronting uninsured and underinsured Americans and U.S. businesses. Leading politicians continue to put campaign contributions from the health insurance and pharmaceutical industries ahead of the interests of other businesses and the American public. However, as U.S. businesses are faced with ever increasing health insurance premiums, more are willing to tackle the crisis and become a part of the solution.

In an October address, Dr. Henry E. Simmons, president of the National Coalition on Health Care, the nation’s largest health care alliance, said: “The escalation of health care costs is no longer only a health care issue. It has now created a gigantic national economic problem. For as these costs rise, they slow the rate of economic growth. By cutting into corporate operating margins, they reduce the capacity of firms to grow by investing in research, plant and equipment. And they put American firms at a steep disadvantage in world markets, where they have to compete against companies in countries with much lower health care costs.”

Ever-increasing health insurance premiums put small businesses in a bind. They often face the impossible choice of providing jobs or health insurance. In addition to the direct costs of insurance, each small business pays staff to deal with health insurance brokers/companies. Employers who can’t afford a staff person often conduct negotiations themselves. All this time and money spent on the complex array of health insurance “gotchas,” multiplied across thousands of small businesses in Colorado, represent millions of dollars that could be invested elsewhere.

Health insurance coverage also impacts the ability to attract and retain employees:

* If a small business doesn’t offer health insurance, potential employees may not consider its job openings.

* A business that offers insurance must be careful whom it hires since one person with a serious health problem could drive premiums sky high.

* A business providing health insurance is likely to have higher labor costs than a nonproviding competitor, putting it at a disadvantage in bidding situations.

Large businesses also are stymied. S. Gary Snodgrass, executive vice president of Exelon Corp., one of the country’s largest public utilities, said health coverage for its employees and retirees is its fastest-growing expense. Between 2001 and 2004, he said, those costs rose 70 percent, forcing the company to shift more of the burden to workers.

Ford Motor Co. spent almost $12,500 per hourly employee and retiree on health care expenses in 2002. William Clay Ford Jr., executive chairman of the board, said the rising cost of health benefits is the “biggest issue on our plate that we can’t solve. Health care is out of control. It’s a system that’s broke.”

In the fall of 2002, the Big Three automakers in Canada said: “The (Canadian) public health care system significantly reduces total labor costs for automobile manufacturing firms, compared to the cost of equivalent private insurance services purchased by U.S.-based automakers; these health insurance savings can amount to several dollars per hour of labor worked. Publicly funded health care thus accounts for a significant portion of Canada’s overall labor cost advantage in auto assembly, vs. the U.S., which in turn has been a significant factor in maintaining and attracting new auto investment to Canada.”

In June 2005, Toyota placed a new plant in Ontario instead of the United States, and health care costs were a key consideration.

The Canadian system reduces the role of the insurance industry – and, hence, the administrative burden on the health care system. Applying the Canadian model to the U.S. means that instead of having more than 1,200 private health insurers – each with its own costly bureaucracy and concomitant expenses – there would be only one group in each state dealing with administration. The Canadian health care delivery system is private, but the financing is public. It is a tax-based system costing far less than we pay in the U.S.

Health care expenses in the U.S. consume about 16 percent of our GDP vs. about 10 percent in Canada. The U.S. “system” is wasteful, with as much as 25 percent of premiums used for things other than health care. More importantly, the Canadian system covers everyone with comprehensive medical care, whereas our “system” fails to cover almost 47 million Americans, and another 30 million to 50 million are underinsured.

Studies by the Government Accounting Office and the Congressional Budget Office show that the single-payer system – public funding and private health care – can provide universal comprehensive coverage here and save money over the current failed market-based approach. These studies are supported by a May 2005 report by Kenneth Thorpe for the National Coalition on Health Care. Thorpe is the former top economist at the Department of Health and Human Services and now is chairman of the Health Policy and Management Department of Emory University in Atlanta. The report projected a saving of $1.1 trillion in the first 10 years under a universal, publicly financed system – even while insurance coverage is extended to every American and stronger quality measures are put in place, a far larger savings than other proposals for reforming the U.S. market-based health insurance system.

Under the single-payer approach, business saves because it would not waste resources researching health insurance decisions, and workers compensation costs would drop due to removal of the health care component. The playing field would be leveled in hiring and in competitive bidding. Uncertainty about health care costs would be eliminated. Large companies would boost their competitiveness in international markets.

Business can best protect its interests by supporting the single-payer bill now in Congress, H.R. 676. Among the 55 co-sponsors of this bill, none is from Colorado. If major surgery is not performed on the U.S. health care system, U.S. businesses and tens of millions of Americans will continue to pay a steep price for the failure to act.

Ron Forthofer is a retired professor of biostatistics at the University of Texas School of Public Health in Houston. A resident of Longmont, he was the Green Party candidate for governor of Colorado in 2002 and won 4 percent of the vote in Colorado’s 2nd Congressional District in 2000. He can be reached at ron_forthofer@yahoo.com.

The Corporate Crime of Selling Private Health Insurance

by The Corporate Crime Reporter

In most of the world, it is a corporate crime to sell private health insurance.That’s because most countries insure their citizens as a matter of right.

Private insurers dilute the public pool.

One nation, one payer.

Medicare for all.

Everybody in, nobody out.

No bills from the doctor.

No bills from the hospital.

No deductibles.

No co-pays.

No in network.

No out of network.

No corporate profits.

No threat of bankruptcy from health bills.

Health insurance will be the number one domestic political issue in the USA in 2008.

Polls indicate that the majority of the American people want single payer.

But who will deliver?

On Saturday, the Center for American Progress Action Fund and Service Employees International Union (SEIU) sponsored a forum in Las Vegas for presidential candidates to discuss health care.

No Republicans accepted.

Seven Democrats accepted.

All the candidates at the forum agreed that universal health care was the goal. (Even the Business Roundtable and the insurance industry now say they want “universal health care.”)

But only one – Congressman Dennis Kucinich (D-Ohio) – accepts the only answer that will work – single payer.

Medicare for all.

The rest – including Barack Obama, Hillary Clinton, Chris Dodd, Bill Richardson, Mike Gravel, and John Edwards – want some mixture of public and private health insurance.

They know this public/private mix won’t work – the healthy wealthy will buy private insurance, the sick poor will sign on with the government – and the government program will be crippled.

But they don’t have the guts to stand up to the private insurance industry and say – get out.

Kucinich has introduced single payer legislation (HR 676) in Congress that would make it unlawful to sell private health insurance for benefits that are medically necessary.

Last week, we entered the belly of the beast – the American Health Insurance Plans (AHIP) 2007 National Policy Forum at the Capital Hilton in Washington, D.C.

AHIP is the trade association for the companies that will be sacked if single payer becomes law.

We walked into a session titled – Coverage for All Americans: Putting Access at the Top of the National Agenda.

The session was moderated by AHIP President Karen Ignagni.

Not once during the 90-minute session was single payer mentioned.

Universal coverage, yes.

Single payer, no.

But during the discussion, the geography of nowhere was laid out.

On one side, Ron Pollack, executive director of Families USA had teamed up with AHIP’s Ignagni.

On the other, Bill Novelli, CEO of AARP and John Catsellani, president of the Business Roundtable.

AARP and the Business Roundtable have joined with SEIU to form something called Divided We Fail.

Divided We Fail is a corporate liberal answer to single payer.

All Americans should have access to affordable quality health care.

All Americans should have peace of mind about their future long-term financial security.

Families USA and AHIP do a separate dance but mouth similar platitudes.

But both Divided We Fail and Families USA/AHIP dismiss single payer as unworkable.

On the single payer side is Kucinich, about 60 members of the House of Representatives, the California Nurses Association, Physicians for a National Health Program, and Health Care Now.

Kucinich is now the single payer champion.

The problem with Kucinich, of course, is that if he doesn’t get the nomination, he will take the stage at the Democratic Convention in 2008 in Denver – as he did in 2004 in Boston – raise the hand of the corporate nominee and endorse the corporate platform.

Then where will we be?

Nowhere.

Again.

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Association-sponsored coverage plummets

Health insurance options dwindle for self-employed

Group plans are being dropped or becoming unaffordable to many.

By Lisa Girion
Los Angeles Times
March 27, 2007

A major source of health insurance for people who work for themselves is disappearing, casting thousands of contractors, freelancers and solo practitioners into the ranks of the uninsured with little hope of obtaining new coverage.

Health plans offered by professional associations were once havens for millions of people who couldn’t get coverage anywhere else. But as medical costs have soared, groups representing professions as varied as law and golf have been forced to stop offering the benefit or been dropped by insurers.

More than 8,000 people with coverage through the California Assn. of Realtors could be next if Blue Shield of California succeeds with its plan to cancel the group’s health coverage.

“It’s a real stab in the heart,” said Marcy Garber, 62, an Encino real estate agent whose history of breast cancer makes her an almost-certain reject if she seeks similar coverage on her own.

Although no one tracks association coverage to know how many plans have disappeared, the experience of Marsh Affinity Services is telling. A decade ago, Marsh, which brokers and administers the health plans, had 142 such clients. Today, all but three have shut down.

In its heyday, association health coverage was so popular that brokers touted it as a membership recruiting tool for professional organizations. The demise of the coverage is particularly problematic in states like California, experts say, where a raft of jobs — including many in the service and entertainment sectors — don’t come with health benefits.

“The problem with associations is they go into a death spiral because they get the worst risk,” said Alan Fox, vice president of plan design for the American Psychological Assn. Insurance Trust, which covered thousands of psychologists and their families for 35 years before discontinuing its health plan in 1999.

As havens for people with medical conditions, association health plans are especially vulnerable to rising medical costs, said Janet Trautwein, chief executive of the National Assn. of Health Underwriters.

“Costs are going up everywhere in every type of plan,” Trautwein said. Associations “not only have the normal costs going up, but they have this adverse selection at the same time. It’s a double whammy.”

http://www.latimes.com/business/la-fi-insure27mar27,0,2749192,full.story

Comment:

By Don McCanne, MD

How many more examples do we need? Segregated health insurance risk pools are not effective for financing care of those individuals who have significant health care needs. We desperately need to establish one single risk pool, include everyone, and fund it equitably.

Republicans are well represented in these professional associations, but simply being a Republican will not provide financial security if you have breast cancer and have run out of insurance options. Reform is no longer a partisan issue. Moderates, conservatives and liberals should all have the health care they need, when they need it, without being exposed to the additional burden of financial hardship. We can do this together.

Health coverage for more people just helps insurers

By Milton Fisk
The Journal Gazette
03/26/2007

Suddenly, the most unlikely bunch has turned altruistic. Conservative businesses and politicians want health coverage for the uninsured. Schemes are multiplying about how to do it. Why the change of heart? Beware of those bearing gifts — this altruism is but poorly disguised self-interest.

Look at some apostles of this new altruism. Wal-Mart is an easy case; it hopes to use it to avoid paying any more for health benefits. Why Gov. Arnold Schwarzenegger? He hopes to garner more dollars for powerful private insurers he needs.

What are these schemes?

Common to all of them is the use of public subsidies so the uninsured can buy private insurance. However, spreading private insurance worsens the problems it creates.

The idea came from President Bush’s 2003 Medicare Plan D drug program, by which private insurers get public subsidies. It’s unadulterated corporate welfare. The drug companies get $40 billion a year more because Medicare can’t bargain over what it charges. The insurers’ ads and profits cost the government $5 billion a year.

With Medicare Plan D as inspiration, don’t expect much from our new altruists. Covering more people is an admirable goal. Getting it through private insurance will push inflation in health care through the roof. To modulate this inflation, we’d need public insurance — Medicare (A and B) is an example — extended to all.

In 2005, CEOs at five big insurers received together a total of $14 million plus stock options and grants for over 2 million shares. The aggregate profits in 2006 of these insurers were $12 billion. Still, their premiums have nearly doubled in the past decade. A public insurer seeks no profits, and its chieftains don’t become plutocrats.

Don’t stop here — there’s more to being an expensive parasite. Premiums for private insurance go to marketing as well as health care: the TV ads, junk mail, public relations accounts to burnish a bad image and hucksters signing on employers and hospitals. There’s little of this waste with public insurance.

Then there’s the cost of underwriting — trying to find whose poor health warrants a bigger premium, whose pre-existing conditions will deny them coverage and who to dump from the rolls. This cherry-picking is absent with public insurance; there’s no extra charge or denial for bad luck or poor genes.

Schwarzenegger wants insurers in his state to devote at least 85 percent of premiums to health care. WellPoint says it devotes only 81 percent; as a California giant, its screams will get Arnold back on track. This bickering is juvenile when Medicare has overhead of 3 percent.

Hang on for more — add to private insurers’ overhead a ripple effect on providers. Doctors and hospitals must send bills to multiple insurers. With a single public payer, this inefficiency disappears. Hospitals won’t have to bill insurers; they will operate under annual budgets negotiated with that single payer.

Shouldn’t the competition between multiple insurers save money?

Free enterprise versus big government? That’s not the fight. It’s rather: Pay more or pay less?

When a new altruist says he or she wants more people covered, ask, “Do you want to expand business for private insurers or do you want to reduce inflation in health care costs by having a single public insurer?”

Milton Fisk, a Bloomington resident, is a member of Hoosiers for a Commonsense Health Plan. He wrote this for Indiana newspapers.