PNHP

The president's new reform proposal

The president's new reform proposal

Bush Seeks Shift in Health Coverage

He Would Tax Those With Higher-Priced Plans, Give Breaks for Buying Cheaper Ones

By Michael A. Fletcher
The Washington Post
January 21, 2007

President Bush will propose a deep tax break for Americans who purchase their own medical insurance and would finance it with an unprecedented tax on a portion of high-priced health-care plans that workers receive from their employers, according to the White House.

Under the president’s proposal, workers who receive employer-provided health insurance would have to pay a tax on the cost of their benefit above $15,000, the threshold proposed by Bush for the tax break.

People with families who buy low-cost policies, meanwhile, would have their taxable income reduced by $15,000, regardless of the cost of the plans and whether they itemize deductions on their tax returns. The deduction would be $7,500 for single individuals. The deduction, to be indexed to account for inflation, would also be extended to those with employer-provided plans, to be offset by the cost of their coverage.

The Bush administration estimates that 80 percent of people with employer-provided plans would see their tax liability fall because the deduction would be larger than the value of their insurance plans.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/20/AR2007012000468.html

Comment:

By Don McCanne, MD

By giving every family with health insurance a $15,000 deduction from their taxable income, the president provides incentives to buy less expensive plans, since the tax benefit is the same for the cheapest plan and every other plan up to a value of $15,000.

Why would the president want to provide tax incentives to encourage individuals to buy cheaper health plans? He claims that insurance causes patients to over-utilize health care, and that health care costs will not be controlled until we end this waste. The fact is that the savings achieved by having the healthy decline services of marginal value is only a minuscule portion of our total health care budget. Most health care is provided to sick or injured individuals who need the care. The cheaper plans that the president is encouraging will increase out-of-pocket costs, often making actual health care unaffordable for precisely those who really do need it.

A further potential impact is that employers who would like to terminate their health benefit programs would have less incentive to continue to provide coverage since the employee now would become eligible for the $15,000 deduction. This further advances the president’s goal of shifting responsibility to the individual through an expansion of the ownership society – wherein you own the right to pay for your medical care.

His proposal also is a regressive method of funding health care. Since every insured individual receives the same deduction, higher-income individuals receive a greater government subsidy because of our graduated tax schedule. Worse, for individuals with modest incomes, the tax subsidy is not enough to make insurance affordable, and they will continue to do without.

At a time when everyone agrees that major reform is essential, the president comes up with this proposal. Doesn’t he care about us?

Letters: Rethinking health care options

Flies in Register's ointment

Saturday, January 6, 2007
Orange County Register

The Register’s editorial, “A healthy dose of free-market forces”[Jan. 2], makes a case for controlling health care spending by reducing government insurance programs and encouraging lower-cost private coverage options that shift more of the spending responsibility to the individual. Such changes theoretically would reduce the “perverse
incentives” to obtain too much care if the individual had to pay for it directly.

The problem with this theory is that most of us need very little care, and the marginal services that we would decline are only a very small fraction of our nation’s total health care bill.

The real reduction in spending would occur with average-income individuals who develop major medical problems and need care.

This reduction would not be the result of informed health care shopping, but it would occur simply because the individuals could not pay the out-of-pocket expenses that would be required by the stripped-down, lower-cost plans.

This is not simply theory, since it has been well documented repeatedly in the health policy literature.

If we follow the Register’s recommendations, hundreds of thousands will suffer needlessly, and tens of thousands will die.

Don McCanne, M.D.
San Juan Capistrano

Register’s editorial: http://www.ocregister.com/ocregister/opinion/editorials/article_1401774.php

Massachusetts premiums to average $380 a month

Sticker shock for state care plan

Average premium of $380 outlined

By Alice Dembner
Boston Globe Staff
January 20, 2007

A state panel yesterday outlined for the first time the minimum requirements for coverage under the state’s new health insurance law, a package estimated to cost $380 a month on average for an individual, more than $100 above recent estimates.

Panel members struggled yesterday to balance affordability with protection from catastrophic medical bills and remained divided on many issues.

“If we’re going to mandate this, people need to see that they’re getting some value,” said panel member Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology. But, he added, the premium is “bad news.”

“I’m trying to think of something to get this number down,” he said.

The minimum plan would limit annual out-of-pocket expenses to $5,000 for an individual and $7,500 for a family and include prescription drug coverage, according to the proposal by a subcommittee of the Commonwealth Health Insurance Connector board, which is implementing the new law. The full board will vote on the proposal Monday.

As proposed, deductibles would run no higher than $2,000 per individual and $4,000 per family. Before the deductible kicks in, the plan would have to cover some medical visits and generic drugs to encourage preventive care. Insurers could not set limits on coverage per sickness, year, or lifetime, nor could they set a dollar maximum of coverage for any medical service.

Immediate reaction to the requirements was negative. Advocates for the uninsured were stunned at the price, considerably higher than the $200 estimated by Mitt Romney when he was governor and first proposed universal coverage. A spokesman for insurers said the requirements were too prescriptive and could undermine the goal of universal coverage.

Under the state’s universal health insurance law, all adults must obtain insurance coverage by July 1 or pay a penalty, unless they secure a waiver by proving they can’t afford insurance. Individuals earning less than 300 percent of the poverty level , or $29,400, are eligible for a separate, state-subsidized insurance package. Young adults, ages 19 to 26, must get some insurance, but will be eligible for less comprehensive and less expensive plans.

For the uninsured who do not qualify for the state-subsidized plans, an estimated 160,000 to 200,000 people, the minimum plan probably would be the least expensive they could buy. Some of the premiums probably would be subsidized by employers.

The estimate of $380 a month in premiums came from a summary of initial bids by insurance companies. Actual premiums will not be set for months.

To meet the state mandate, at least 40,000 people who now have insurance probably would have to buy additional coverage since their plans do not meet the proposed new standard, Connector staff members said. In addition, some employers who now provide more extensive coverage could cut back to the minimum.

The five members of the policy committee argued yesterday about how prescriptive the rules should be. After the 10-member board votes on the requirements Monday, there will be a public hearing on Feb. 16, and then the rules could be revised. However, the board needs to move quickly if new health plans are to be ready for the public by July.

Until Monday’s meeting, groups representing residents, insurers, hospitals, and others will be lobbying board members.

“For a large proportion of the folks not eligible for subsidized care, the bare minimum plan is flat-out unaffordable, not only because of the premiums, but the deductibles and out-of-pocket expenses,” said John McDonough, executive director of Health Care for All, an advocacy group that supports the health law. “This is a significant disappointment. We think the Connector and particularly the insurers need to go back to the drawing board.”

Health Care for All had suggested that the minimum plan cover prescription drugs, and that the drugs not be subject to a deductible. In addition, they suggested a cap of $3,000 on out-of-pocket expenses, and a maximum deductible of $1,100.

Eric Linzer, vice president of the Massachusetts Association of Health Plans, said the Connector committee’s recommendations were boxing insurers into a corner.

“There’s really a limited number of ways you can make premiums affordable,” he said. “If the minimum credible coverage is too high and coverage is unaffordable, it runs the risk of not achieving universal coverage.” Linzer said there might also be thousands of people satisfied with their coverage whose plans do not meet the proposed standard.

Based on information from actuaries reviewed by the board last fall, the panel had expected to get plans with a premium of about $260.

But most of the insurers’ bids, the details of which have not been made public, came in much higher , according to Connector board staff.

For one group of HMO-type plans, the premiums ranged from $250 for a 28-year-old to $500 for a 56-year-old.

In deciding on the proposed minimums, panel members debated how best to serve individuals with high medical expenses, as well as those who are healthy.

“We’ve got to protect the people” with high costs, said Bruce Butler, an actuarial consultant who chairs the policy committee. “But it’s a balancing issue with affordability.” Later, he added, “There’s no one part of it you feel good about, but it’s the best overall.”

Panel members were reluctant to strip the plan of benefits to bring down the cost to consumers. “There’s not only the issue of affordability, but also what provides legitimate protection,” said panel member Dolores Mitchell, executive director of the Group Insurance Commission.

Another member, Celia Wcislo, assistant division director of labor union 1199 SEIU, argued for more preventive coverage, including doctors’ visits and drug coverage before the deductible applies, and for a lower deductible, saying that high initial costs could prevent people from getting care.

The board’s executive director, Jon Kingsdale, who does not vote, urged the panel to consider what rules could be enforced and suggested they not specify every detail of coverage.

“I feel very, very nervous about that,” he said. “There’s going to be a court challenge” to whatever the board decides, he predicted.

Under the law, anyone without insurance who meets the minimal standard would forfeit their personal tax exemption for 2007, costing them about $200.

In 2008, they would be fined half of the average premium for the minimal plan.

(C) Copyright 2007 Globe Newspaper Company.

U.S. should focus on finding cure to health-care debacle

WILLIAM CONNOLLY, Columnist
The Evansville Courier & Press
Sunday, January 21, 2007

According to a recent Parade Magazine article by David Wallechinsky, patriotic sentiments notwithstanding, while the United States is still No. 1 in some respects – Nobel prize winners, billionaires and armed forces stationed in other countries – we lag far behind in other categories that more accurately assess social well-being. We lag behind other countries when it comes to health care. Thirty-three countries, including Cuba, have lower infant death rates; 43 have more physicians per capita, including France, Switzerland, Mongolia and Lebanon; and 49 have more hospital beds per capita, including England, Italy and Ireland.

We rank 29th in maternal death rate, 30th in life expectancy for women and 28th for men. All this despite our spending more per capita on health care ($5,700) and as a percentage of gross domestic product (more than 15 percent), higher than any other country.

So why don’t we do better? Perhaps this is a matter of lifestyle. We consume too many calories – we’re No. 1 in obesity. Despite being obsessed with sports, most of the time we are only spectators, not participants. We are inactive at all ages. We have the 15th highest murder rate.

The data also reflect an ailing health-care system, afflicted with confusing, conflicting and inefficient ways of financing care. Most comes from private insurance tied to employment. That system leaves more than 45 million Americans uninsured.

Because the system is composed primarily of the working poor, they end up served by inadequately funded public assistance. They postpone treatment and rely on more expensive emergency care, funded indirectly by the insured. This indirectly increases their costs. As the U.S auto industries have learned, the costs further harm their global competitiveness.

But there is some good news on the horizon. While Washington has provided little leadership, states are beginning to explore alternatives. California Gov. Arnold Schwarzenegger recently promoted an ambitious plan to provide coverage for all Californians. His goal is commendable because his plan promises universal coverage, requiring all to buy health insurance.

Those who cannot afford it will be provided financial assistance. Insurance companies are required to sell insurance to everyone at the same price. It would enable people to obtain preventive care rather than wait for more expensive emergency care. Since insurers have to provide coverage to everyone, they would not waste resources trying to deny coverage. This would allow for more spending on actual care. Furthermore, insurers would have to spend at least 85 percent of premiums on health care, which is quite the improvement.

The program will, however, result in substantial government intrusion to ensure that people buy insurance. It will also determine who will receive assistance and police insurers, guaranteeing their compliance. All of this seems necessary to keep insurance companies in the game. This may make Schwarzenegger’s proposal more politically appealing to insurance companies that plan to do well in this program. However, this complex interplay of private insurers and government killed the Clinton proposals in the early 1990s.

Why not eliminate the middleman and opt for a single-payer system similar to Medicare, contributed to by everyone, including employers? It would be simpler – and cheaper – for employers and health-care providers.

This is a worthwhile debate. While I believe a single-payer system would be better, Schwarzenegger deserves credit for bringing the issue to the table.

http://www.courierpress.com/news/2007/jan/21/us-should-focus-on-finding-cure-to-health-care/?printer=1/

(c) 2006 The Evansville Courier Co.

The president’s new reform proposal

Bush Seeks Shift in Health Coverage

He Would Tax Those With Higher-Priced Plans, Give Breaks for Buying Cheaper Ones

By Michael A. Fletcher
The Washington Post
January 21, 2007

President Bush will propose a deep tax break for Americans who purchase their own medical insurance and would finance it with an unprecedented tax on a portion of high-priced health-care plans that workers receive from their employers, according to the White House.

Under the president’s proposal, workers who receive employer-provided health insurance would have to pay a tax on the cost of their benefit above $15,000, the threshold proposed by Bush for the tax break.

People with families who buy low-cost policies, meanwhile, would have their taxable income reduced by $15,000, regardless of the cost of the plans and whether they itemize deductions on their tax returns. The deduction would be $7,500 for single individuals. The deduction, to be indexed to account for inflation, would also be extended to those with employer-provided plans, to be offset by the cost of their coverage.

The Bush administration estimates that 80 percent of people with employer-provided plans would see their tax liability fall because the deduction would be larger than the value of their insurance plans.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/20/AR2007012000468.html

Comment:

By Don McCanne, MD

By giving every family with health insurance a $15,000 deduction from their taxable income, the president provides incentives to buy less expensive plans, since the tax benefit is the same for the cheapest plan and every other plan up to a value of $15,000.

Why would the president want to provide tax incentives to encourage individuals to buy cheaper health plans? He claims that insurance causes patients to over-utilize health care, and that health care costs will not be controlled until we end this waste. The fact is that the savings achieved by having the healthy decline services of marginal value is only a minuscule portion of our total health care budget. Most health care is provided to sick or injured individuals who need the care. The cheaper plans that the president is encouraging will increase out-of-pocket costs, often making actual health care unaffordable for precisely those who really do need it.

A further potential impact is that employers who would like to terminate their health benefit programs would have less incentive to continue to provide coverage since the employee now would become eligible for the $15,000 deduction. This further advances the president’s goal of shifting responsibility to the individual through an expansion of the ownership society – wherein you own the right to pay for your medical care.

His proposal also is a regressive method of funding health care. Since every insured individual receives the same deduction, higher-income individuals receive a greater government subsidy because of our graduated tax schedule. Worse, for individuals with modest incomes, the tax subsidy is not enough to make insurance affordable, and they will continue to do without.

At a time when everyone agrees that major reform is essential, the president comes up with this proposal. Doesn’t he care about us?

TNR Editorial on Compromise

Mr. Universe

by the Editors
The New Republic
January 29, 2007

For years, Republicans have attacked advocates of universal health insurance as “socialists.” But what are they going to call Arnold Schwarzenegger? Last Monday, the Republican governor announced that he wants to bring universal coverage to California–just as another Republican governor, Mitt Romney, recently did for Massachusetts.

When prominent Republicans start embracing universal coverage, it’s a sign that the next great debate about health care has begun.

But how will it end? A lot depends on how liberals react to proposals like Schwarzenegger’s. On the one hand, his plan represents a clear departure from the previous decade, when even Democrats limited themselves to incrementalism. It would give coverage to virtually every California citizen and would break some important political taboos along the way. The plan features extensive regulations of the insurance industry, so that it cannot exclude people with prior medical conditions. It also has higher taxes and requirements that employers contribute toward health insurance. There is even bigger government, in the form of expanded Medicaid.

Still, the plan has some serious drawbacks. For one thing, its minimum-benefits package seems meager, which could encourage employers who now offer more generous coverage to cut back. For another, its financing scheme makes some heroic assumptions about the savings that reform will produce.

But perhaps the biggest problem with Schwarzenegger’s plan is the danger that it could stall momentum for more sweeping changes–both in California and beyond. His proposal arrives on the heels of a measure he vetoed last year that would have created a single-payer system–the most comprehensive type of reform, in that it seeks to blow up the entire health care system and have government insure citizens directly. Yet even people who support single-payer may be tempted to rally around schemes like Schwarzenegger’s, which have more limited ambitions, because they might fear their preferred plans couldn’t pass.

But it’s not self-evident that moderate plans are so politically viable, either. Consider what happened to Bill Clinton, who tried desperately to blunt the opposition of special interest groups and get past Americans’ well-known skepticism of government.

At the very least, it’s premature for would-be reformers to “settle” on a plan that, like Schwarzenegger’s, has some major flaws. If this plan defines the outer limits of political acceptability, then whatever compromise it finally produces will likely have even greater deficiencies.

Yes, champions of universal coverage should welcome the likes of Schwarzenegger to their cause. But these common areas of belief should be the beginning of discussion, not the end. There is a time for compromise, and that time will come soon enough. But, right now, advocates of universal health care should speak openly and unabashedly about what they actually believe is right, even if that means proclaiming ambitions that defy conventional notions of the politically possible. That is how you stretch the boundaries of debate. And that is how reform, eventually, will happen.

http://www.tnr.com/doc.mhtml?i=20070129&s=editorial070129

Comment:

By Don McCanne, MD

The voices of compromise are very loud right now. Ours must be heard loud and clear above the din.

Proposal of the Health Coverage Coalition for the Uninsured

Expanding Health Care Coverage in the United States: A Historic Agreement

Health Coverage Coalition for the Uninsured
January 18, 2007

Signatory organizations:
AARP, America’s Health Insurance Plans, American Academy of Family Physicians, American Hospital Association, American Medical Association, American Public Health Association , BlueCross BlueShield Association, Catholic Health Association, Families USA, Federation of American Hospitals, Healthcare Leadership Council, Johnson & Johnson, Kaiser Permanente, Pfizer, UnitedHealth Group, U.S. Chamber of Commerce

A diverse group of 16 major national organizations with an abiding interest in accessibility to quality health care have reached a consensus on policy approaches to expand health coverage to as many people as possible as soon as possible.

Phase I: The “Kids First” Initiative and State Experimentation

Public Program Enrollment

…improve enrollment of children who are uninsured but currently eligible for SCHIP (State Children’s Health Insurance Program) and Medicaid.

Family Tax Credit

…creates a new family tax credit for the purchase of children’s health coverage…

State Demonstration Program

…establishes a state demonstration program giving states flexibility to experiment with new approaches that expand health coverage. Competitive grants would be provided to the states…

Phase II: Longer-Term Policy Recommendations

Public-Sector Proposals

…allow states to eliminate family status as an eligibility requirement and determine eligibility for Medicaid coverage based exclusively on financial need.

Private-Sector Proposals

Make… tax credits available for individuals and families with incomes between 100 and 300 percent of the federal poverty level for the purchase of health coverage. …graduated on a sliding scale based on income.

Provide federal grants to states in order to provide health coverage for high-risk populations.

Coalition’s home page:
http://www.coalitionfortheuninsured.org/

The “Historic Agreement:”
http://www.coalitionfortheuninsured.org/pdfs/agreement.pdf

Comment:

By Don McCanne, MD

What a tragedy. Health care coverage, affordability and access are rapidly deteriorating at an accelerated pace, and this is the best that this coalition of influential organizations can come up with.

They propose moving reform forward a couple of inches when we are sliding thousands of miles backwards.

You can cross this group off your list.

Marchers rally for single-payer health care

by Lorna Benson
Minnesota Public Radio
January 15, 2007

Single-payer health insurance advocates recalled the words of Dr. Martin Luther King on Monday as they made their case for health care reform during an annual Martin Luther King Jr. Day march in St. Paul. They also called on state lawmakers to take a bolder approach to fixing Minnesota’s health care system.

St. Paul, Minn. — Single-payer supporters say this is the first time they’ve paired their cause with St. Paul’s annual Martin Luther King Jr. Day march from Central High School to Concordia University. But the Minnesota Universal Health Care Coalition says the pairing actually makes perfect sense.

The organization’s vice chair, Dr. Jim Hart, says King was deeply troubled by health care inequality. To prove that point, single-payer marchers carried banners quoting King that said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Hart says, like King, single-payer advocates believe that all Americans could and should have health care. But he says the U.S. will never achieve that goal with its current market-oriented system.

“We spend about 20-percent of our health care dollar on insurance functions, both at the insurance companies and at the clinics and hospitals that have to deal with this complicated system. So there would be ways to save but it would take a bolder approach than what we’re seeing so far,” he said.

Hart says single payer is that bolder approach. Often the mere mention of that model elicits groans from people who see it as leading to the rationing of health care. But fellow marcher Dr. Chris Reif says the definition of single payer is not necessarily what people assume.

“Single payer doesn’t mean it always happens the same way,” Reif said. “It just means that you try to get the economies of scale and try to get better care. Right now there’s a move, like in Utah, to have single application forms for insurance. That’s one step toward single payer. There’s also a move to have our electronic medical records be the same or talk to each other. That’s a move toward single payer.”

If those arguments don’t win over skeptics, single-payer advocates believe the eroding health insurance market will.

Eric Angell is with the Universal Health Care Action Network, another single payer organization that also marched at the King Day rally. Angel points to a recent vote by thousands of Twin Cities janitors who agreed to walk off the job if they don’t get a more affordable health-care package.

“This is not an anomaly,” according to Angell. “A lot of other unions have decided to go on strike for the exact same reason: the rising health care costs. Employers are not able to provide health care to their employees the way they once did and the obvious reason is the rising health care costs.”

Angell says he’s skeptical about lawmakers’ willingness to look seriously at a single-payer system. But Dr. Jim Hart says he’s impressed by at least one bill at the Capitol this session that would extend health care coverage to all children in Minnesota. Hart says the bill uses a single-payer approach to making health care affordable for kids.

Sen. John Marty, DFL-Roseville, who also participated in the march, says if lawmakers passing the “cover all kids” bill, it would be a huge step. But he says he’s already detecting some backtracking among people who originally supported the idea.

“It’s certainly a tough fight,” Marty said. “We’re not used to thinking this way. Much of the rest of the world does think that way but in the U.S. the health care industry is set up in a way that doesn’t cover people and I think there’s been a lack of vision in the political system.” Rep. Keith Ellison campaigned on a single-payer system before getting elected to Congress. He says he still believes in the approach and will push the idea in Washington. But he says Minnesota lawmakers need to do their part too.

“Everybody should do what they can do. We’re not putting the brakes on any effort,” Ellison said. “If we can get a single-payer program in the state of Minnesota, great. If we can do it at the federal level, great. Ultimately it has to be a nationwide thing. But maybe a step toward that goal is a statewide program.”

Ultimately single-payer advocates would like to see the state take over the way health care is financed. They admit there are plenty of obstacles to that goal. But they believe Minnesotans are more receptive to the idea now than they’ve ever been.

It's time for national program

By TERRY HAVENER
The Tribune-Democrat
January 16, 2007

As a citizen of this great nation, my health care should not be a privilege. It should be a right — not a handout but a true entitlement.

And not something I either pay for or beg for, but a given, no-questions-asked guarantee.

The time for national health care is now.

The United States is the only developed, industrialized country that does not provide national health care to its citizens.

Employment-related health care, where a person’s well-being is negotiated along with his or her wages, is becoming a casualty of a global market system that pits American workers against workers in third-world countries.

The current high cost of health care, when linked to global competitiveness, can be a deciding factor in the winning or losing of business opportunities.

More and more, companies are forcing employees to assume the cost of health care. Insurance co-pays and deductibles diminish the worth of workers’ paychecks, and are growing faster than most salaries or cost-of-living increases.

Many union-run health plans are being bankrupted or are being forced to restrict or eliminate coverage.

Meanwhile, the business of health care has become just that — big business. The cost of an individual’s health is based on profit margins, country-club memberships and the price of the most recent trendy luxury car.

Dr. Marcia Angell, a senior lecturer with the Department of Social Medicine at Harvard Medical School and a former editor-in-chief of the New England Journal of Medicine, said, “The underlying problem is that we treat health care like a market commodity instead of a social service.

“Health care is targeted not to medical need, but to the ability to pay. Markets are good for many things, but they are not a good way to distribute health care.”

Legislation proposed in the U.S. House of Representatives, HR 676, would establish a national health plan for all Americans — a Medicare- for-all type plan. Sponsored by Rep. John Conyers Jr. (D-Mich.), it now has 77 co-sponsors.

According to the All Unions Committee for Single Payer Health Care, based in Louisville, Ky., HR 676 has been endorsed by 192 union organizations, including 44 central labor councils and area labor federations, and 12 state AFL-CIOs , including Pennsylvania.

HR 676 is also endorsed by Physicians for a National Health Program. PNHP is a single-issue organization with more than 14,000 members. It advocates a universal, comprehensive, single-payer national health program.

So unless you are completely satisfied with your health-care plan and its delivery system, get involved.

Voice your concerns to your legislator and urge him or her to sign on to HR 676.

The health of our nation is too important for anyone to stand on the sidelines.

Hospitals cure bill ills with liens

Notice in mail surprises some patients

News-Journal
West Volusia edition

Tripping on the rug in his Port Orange home sent Glenn Hibbs on a financial odyssey he wishes he’d never been forced to take.

He broke his shoulder and before it was put back together, Halifax Medical Center had a $26,000 claim — a lien — on Hibbs’ home. The hospital insisted he sign financial responsibility forms before being admitted for treatment.

“I signed it with a broken shoulder,” said Hibbs, 50, who has no health insurance. “They told me I had to sign or there would be no surgery.”

Increasingly, three local hospitals — Halifax Medical Center, Florida Hospital DeLand and Florida Hospital Fish Memorial — are recording liens against patients with the Volusia County Clerk of Court when there’s been an accident, even when the patient has health insurance.

Since 1999, the number of liens Halifax has filed has more than quadrupled to 2,159 liens filed in 2005. And the stakes have skyrocketed: In September, Halifax Medical Center, the area’s largest hospital, filed $5.2 million in liens compared to the $840,469 in liens filed in September 1999.

At Florida Hospital DeLand, 14 liens were filed in 2001 — the first full year the West Volusia Division of the Adventist Health System operated the hospital — compared to the 349 that were filed in 2005. At Florida Hospital Fish Memorial in Orange City, no liens were filed in 2001, compared to the 125 filed last year. It’s part of a trend, nationwide.

It’s not because the patients haven’t paid or are ignoring notices — these liens are filed automatically, often before the patient leaves the hospital.

Hospital officials say — but some attorneys and property title closers disagree — the vast majority of these liens are not against the person or their property, but against the court or insurance settlement stemming from the accident that caused the hospitalization. The liens, which are allowed by statute in 21 of Florida’s 67 counties, including Volusia, help protect the hospital — and, in Halifax’s case, property taxpayers, hospital administrators say.

“We file liens to make sure that the person doesn’t take the insurance money without passing it to the hospital,” said Harry Reese, chief financial officer for the Halifax Community Health System.

Still, John Reynolds of DeLand said he was stunned to come home from his 16-day hospital stay after a motorcycle crash and discover notice of a registered letter from Halifax waiting in his stack of unopened mail. Medical bills aren’t covered in his motorcycle insurance, he said, so he’s waiting to see how the $122,424.55 hospital bill will be resolved with his health insurance.

“I’m in limbo,” said Reynolds, 52, who worked as a heavy-machine operator before he started receiving Social Security disability years ago.

Similarly, the Hepsworths of Deltona are not only coping with the Sept. 23 death of daughter Krystle Accardi, 14, in a car crash. They also have a lien of more than $92,000 against them from the hospital, resulting from her hospital stay of a little more than 24 hours.

“I don’t know if they can do that,” said Douglas Hepsworth, Krystle’s stepfather, about the lien. They are now waiting to see how much their health insurance will cover. “I think it’s a very questionable area that they are going into there.”

A 1953 legislative act enabled Volusia County hospitals to impose liens before the patient has a chance to pay. Florida Hospital West Volusia Division spokeswoman Stefanie Macfarlane said the number of liens that Florida Hospital DeLand and Fish Memorial are increasing as reimbursement for hospital services has become more difficult.

At Halifax Medical Center, Reese attributed the rise in the number of liens to a change in policy that occurred in November 2000 that meant liens were filed in the cases of all accidents, not just auto accidents. At the same time, the hospital started filing amended liens once the patient accumulated another $25,000 in charges after the initial $10,000.

A Boston-based health-care advocacy nonprofit organization says reports of the use of liens are increasing around the country.

“All hospitals are working to improve their revenue cycle management, which means they are being much more aggressive about collecting bills,” said Betsy Stoll, legal director at Community Catalyst, in an interview from her Boston office. “I think it’s a symptom of the growing number of people without insurance and more of a push onto the person who’s insured.”

Florida law prevents creditors from seizing homesteaded property. And, unless hospitals seek a judgment on outstanding liens, they don’t affect the debtor’s credit or property, officials from local hospitals say. But on this point, attorneys and property title closers disagree.

Debbi Kelley, marketing director and closer at Florida Venture Title, said medical liens are regarded much like outstanding child-support payments — and must be paid before the named person call sell property or refinance it.

“I have run across them in the past, and, for the most part, we have paid them at closing,” Kelley said.

But Daytona Beach Attorney Walter J. Snell said these liens in accidents essentially are uncollected bills — until the hospital decides to seek a judgment.

“The only time they sue is when they know a person owns property,” he said.

County and hospital records show that the number of lien releases is not keeping pace with the number of liens Halifax Medical Center is filing. But Arvin Lewis, vice president for patient business and financial services, said the hospital rarely files for judgment on its liens. The number of judgments the hospital sought has decreased from 175 in 2002 to 51 this year, he said.

“We truly don’t want to file claims against our patients in court,” he said.

Meanwhile, Hibbs’ shoulder has healed from the injury in February, but he’s still shocked at the treatment he received — which, he says, required him and his partner to make a $2,976 payment up front, even before he was diagnosed as needing surgery.

Hibbs, who has a $12-an-hour job at a real estate company, said he hasn’t begun to pay off the lien as he’s still juggling bills from anesthesiology and emergency room services.

The idea that Halifax Medical Center owns a piece of his house is a stinging reminder of his injury.

“We weren’t even given the option of making payments,” he said.

Doctor: Nation needs universal health care

By Chris Outcalt
coutcalt@seacoastonline.com
Portsmouth Herald
Thursday, January 18, 2007

PORTSMOUTH — Thomas Clairmont, a doctor at Portsmouth Regional Hospital, envisions a health care system without co-pays, deductibles or “pre-existing conditions.”

The program would be tier-free and provide health care coverage for everyone in the country. The way he sees it, having access to health care is not an option; it’s a right.

“The path we’re on now is not sustainable,” said Clairmont. “The link between health insurance and employment should be severed.”

Clairmont explained his vision of a national health care plan to a group of about 30 people Wednesday afternoon at the Portsmouth Public Library.

According to Clairmont, a member of Physicians for a National Health Program, something needs to be done to stop the rising number of uninsured people in New Hampshire and across the country.

Insurance costs are increasing at five times the rate of inflation, which has left more than 45 million Americans without health care, according to statistics from the U.S. Census Bureau.

In New Hampshire, 135,000 people, including 17,000 children, are without health insurance.

“With the number of uninsured rising each year and the number of businesses covering their employees steadily decreasing,” said Clairmont, “the time has come to move toward a national health plan.” A single health care plan would also eliminate the complications of choosing and understanding various plans, he said. “It’s dizzying. I can’t understand these plans myself; I don’t know how anybody else does.”

Clairmont urged those in attendance to take advantage of New Hampshire’s first-in-the-nation primary status to “grill” presidential candidates on national health care and write to representatives in support of the National Health Insurance Act.

“Anybody that comes to New Hampshire, we want these people under fire,” he said.

The national health insurance bill, HR 676, would create a publicly financed, privately delivered health care program available to all U.S. residents.

“We have a new opportunity with the Democrats in power,” he said. “We couldn’t have had this discussion a year ago.”

Medicare for All: The Only Sound Solution to Our Healthcare Crisis

By Guy T. Saperstein
AlterNet
Posted January 16, 2007

Our $2 trillion healthcare industry is not only unhealthy, it is unsustainable. Why universal Medicare is the way to get universal healthcare without collapsing the system.

We all know that America’s healthcare system is collapsing. Andy Stern has written that America’s employer-based health insurance system is “dead.” Auto executives troop to the White House complaining that they are not competitive with foreign automakers because they pay $1,500 per car for health insurance. Some of the biggest laughs in movies come when America’s healthcare system is ridiculed. Politicians, even Republicans, are offering solutions.

In the Greenberg Quinlin poll of November 2006 voters, 22 percent ranked healthcare as the most important issue; likewise, MoveOn.org recently polled its members, received over 100,000 responses, and healthcare ranked as the No. 1 concern

To add substance to these observations, consider the following: Not only are 47 million Americans uninsured (approximately 18.5 percent of the insurable market), 41 percent of Americans with incomes of $20,000 to $40,000 did not have health insurance for at least part of 2005, up from 28 percent in 2001; 53 percent with incomes under $20,000 lack health insurance.

The number of people without health insurance rose 16.6 percent from 2001 to 2005; average health insurance premiums for a family of four are $10,880, which exceeds the annual gross income of $10,712 for a full-time, minimum-wage worker; lack of insurance causes 18,000 excess deaths a year; people without health insurance have 25 percent higher mortality rates; and, 59 percent of uninsured people with chronic conditions such as asthma or diabetes skip medicine or go without care.

There are additional costs to the haphazard U.S. healthcare system: More than 50 percent of the U.S. population has medical debt problems; between 1981 and 2001, medical-related bankruptcies increased an astounding 2,200 percent and 55 percent of personal bankruptcies are now caused by illness or medical debts, despite the fact that over 75 percent of the bankrupts had health insurance at the onset of bankruptcy and illness.

Contrary to popular conceptions, the average medical bankrupt was a 41-year old woman with children, some college education; over half owned homes and over 80 percent were in the middle or working classes.

But for the insured, the United States has the best quality healthcare in the world, right? Wrong.

A Second-Rate System

The World Health Organization ranks healthcare systems based on objective measures of medical outcomes: The United States’ healthcare system currently ranks 37th in the world, behind Colombia and Portugal; the United States ranks 44th in the world in infant mortality, behind many impoverished Latin American countries. While infant mortality in the United States is skewed toward poor people, who have rates double the wealthy, the top quintile of the U.S. population has infant mortality rates higher than Canadians in the lowest quintile of wealth.

Out of 30 developed nations, life expectancy in the United States ranks 21st; life expectancy in the United States is 4.6 years less than Japan, 2.1 years less than France and 2.6 years less than Canada. The United States has fewer physicians, nurses and hospital beds than most developed nations. In the United States, 28 percent say it is “difficult to get care”; in most European countries, Japan, Australia and New Zealand, 15 percent say that. In terms of continuity of care (i.e., five-plus years with the same doctor), the United States is the worst of all developed nations. By every objective measure, the United States has a second-rate healthcare system.

OK, the U.S. healthcare system is not performing very well, but that must be a funding problem, right? Wrong.

The Truth About Healthcare Costs

The United States has the most expensive healthcare system on the planet. Even including the 47 million uninsured, the U.S. healthcare system costs almost double per capita what single-payer systems in Europe, Japan and Canada cost; in the United States, healthcare costs were $5,635 per person in 2005.

By contrast, in Japan, with life expectancy 4.6 years more than the United States (presumably a cost-increasing factor), healthcare costs were $2,139 per person; in the United Kingdom, $2,232; Sweden (the ultimate “welfare state”), $2,520; France, $2,903; and, Canada, $3,001.

And, this is not just an individual problem; this is a national problem. Healthcare system costs in the United States are 16 percent of GNP (and currently increasing 14 percent per year); no other country in the world has healthcare costs which exceed 11 percent of GNP and the average among developed nations is 9 percent. As noted above, these high costs are making the U.S. uncompetitive in many areas.

Why is the U.S. healthcare system so expensive? Administrative costs, marketing and profits account for 22 to 31 percent of the U.S. healthcare dollar (I recently heard Edward Kennedy say these costs were 33 percent, but I have not seen documentation of that number). By contrast, overhead costs in single-payer systems (including Medicare) typically are 3 percent.

In America’s for-profit private insurance healthcare system, medical technicians must contend with hundreds of different forms, billing procedures, regulations and requirements from hundreds of insurance companies; U.S. healthcare companies spend money for advertising and marketing; and, the U.S. healthcare system is based on profit. Since 1970, the number of medical doctors in the United States has increased 40 percent, while the number of medical administrators has increased almost 3,000 percent.

We are paying for a massive, inefficient bureaucracy. The increasing cost of prescription drugs also is increasing the healthcare bill, and U.S. drug costs are the highest in the world; Americans pay 30 percent to 80 percent more for prescription drugs than citizens of any other country.

You might think that this excess money goes into developing new drugs, but you would be wrong: Only 13 percent of drug costs go to research and development, and little of that goes for pioneering new drugs to deal with life-threatening conditions; 51 percent goes to marketing, administration and profits.

Recently, one of my adult sons went to a medical office for testing. On completing the tests, he was handed a bill. The bill had two prices: One was the insurance price, $969.25, the second was the “cash pay price,” $678.00 — exactly 30 percent less than the insurance price. What more do you need to know about the excessive cost and inefficiency of the American private health insurance system than that it costs 30 percent more than the underlying medical services are worth?

The public understands this. In the California Field Poll released on Jan. 3, 2007, California voters were asked why healthcare costs are increasing: The No. 1 reason given by voters was “high profits” (65 percent); the number two reason was “waste, fraud and inefficiencies in the current system” (60 percent).

The answer to this problem is not simply “universal health insurance.” “Universal healthcare” that does nothing more than bring more people into the most expensive and inefficient private insurance-based healthcare system on the planet would accelerate the total collapse of the system for everyone.

No credible economist thinks America can sustain healthcare costs exceeding 20 percent of GNP (itself a gigantic burden and drag on economic growth) and adding 47 million more people to the current decrepit system would bring the United States to the 20 percent threshold. Since the costs of our private insurance system currently are rising at the rate of 14 percent per year, the system is unsustainable, by any rational economic analysis.

Single-Payer Solutions

Howard Dean recently identified healthcare as an emerging top-tier political issue and endorsed single-payer, saying at a Democracy Alliance conference in Miami, “It is obvious we are going to need to work toward some form of single-payer system, just like every other industrialized nation. In the next two years, we should expand Medicare and Medicaid to cover every uninsured person under 25.” Dean is an M.D., by the way.

Surely the healthcare system which every other industrialized nation in the world relies on, which is both less expensive and offers improved medical outcomes, and which many think is the only viable and sustainable healthcare system, deserves serious consideration by American progressives and the public, but, to date, single-payer is not being researched and evaluated in America.

I am not arguing that the perfect must be the enemy of the good; there may be intermediate steps that could be taken, rather than proposing that America swallow the big enchilada in one bite. Clearly, Howard Dean’s proposal to cover everyone under 25 is a step down the incremental path, and, as he suggested, probably not even a very expensive one.

What is unacceptable would be to have a political debate which could change healthcare in America for the next 20-30 years, or more — in the process helping to decide elections — without sound progressive ideas and input and without serious consideration of single-payer.

The biggest objection to single-payer I have heard from Democrats is not that single-payer is not a good system, or even the best system, but that it will be attacked as socialized medicine and therefore is not politically viable. Of course, a single-payer system is not socialized medicine.

Medicare is a single-payer system — a very popular one, by the way — and single-payer systems such as Medicare do not employ any doctors or own any hospitals or medical facilities, let alone create bureaucracies approximating the bloated, inefficient bureaucracy the private insurance model has created in America.

Rather than hundreds of payers (insurance companies) and thousands of different forms, regulations and procedures, there would be one payer and one set of forms and procedures. Single-payer also would offer more choice of medical providers; unlike the current system, where patients are limited to panels of providers, in a single-payer system, patients go to any doctor they want, submit a national health insurance card and the government pays — just like Medicare.

Single-payer is the simplest, most efficient, system of all. While single-payer is a government-paid program, American taxpayers already pay more than 60 percent of healthcare costs in America (including tax subsidies). With that much money invested, can’t we demand a system that covers everyone at reasonable cost and with improved performance? Why should we continue to allow 22 percent to 31 percent of healthcare costs to be swallowed by bureaucratic inefficiencies, marketing and profit?

John Garamendi, formerly California’s insurance commissioner and now lieutenant governor, campaigned in favor of single-payer and said repeatedly on the stump: “Are you aware that for 40 years, the United States has had a universal single-payer healthcare system that allows every participant to choose their own doctor, its administrative cost is one-tenth the cost of private insurance and people do everything possible to get into the system (i.e., live to 65). It is Medicare, and no one calls it socialized medicine.”

Insurance Industry Wrath

Of course, the real reason people back away from a single-payer system is fear of insurance industry wrath. We all remember the “Harry and Louise” ad campaign the health insurance industry unleashed on HillaryCare 12 years ago. So, is anyone not afraid of the insurance industry? Is anyone willing to challenge insurance industry profits?

The answer, surprisingly, not only is yes, but the person apparently willing to take on the big ugly bear is a pro-business Republican — The Terminator.

On Jan. 8, California Gov. Arnold Schwarzenegger unveiled his plan to insure all Californians, and while the proposal itself continues to rely on the private insurance model, it provides that insurance companies would be required to spend 85 percent of their revenues on medical services; in other words, insurance company overhead, marketing, administrative costs and profits, would be capped at 15 percent — roughly half of what they currently are.

Does anyone think the insurance industry is not going to fight this incursion on its profits with all its might? Of course it will, and it will fight a halving of its profits just as vigorously as it will fight a single-payer system.

So, if a Republican, pro-business governor of a major state is willing to take on the insurance industry, should progressives be any less courageous in pursuit of real healthcare reform? In short, a very gifted Republican politician has made a calculated decision that fighting the insurance industry not only is not going to hurt him politically, it is going to get him elected to the United States Senate in 2010. It is good politics.

The other political objection to single-payer I have heard is that it is simply too big an idea and too big a proposal.

While this objection is debatable, single-payer need not be adopted whole in one bite; it can be adopted and implemented piece-meal, just as Howard Dean suggested when he said in the next two years we should work to cover the uninsured under age 25 in an expanded Medicare.

There are other inclusions which could be adopted incrementally, such as expanding Medicare to include everyone with incomes under $20,000 per year, then increasing income thresholds until everyone is covered; or, it would be possible to work in age-based increments by expanding Medicare into ever-younger categories of Americans. Conservatives understand the power and effectiveness of “slippery slope” proposals (banning partial birth abortion is one such “slippery slope”).

Let’s put the healthcare agenda on the “slippery slope” to Medicare for all, not work toward more private insurance and inevitable healthcare system insolvency — where most current healthcare proposals (including Democratic) are headed.

Before leaving the subject of political viability, let me briefly address the healthcare proposal put out by the Center for American Progress, which threatens to become the Democratic Party proposal. In general, CAP’s proposal would provide coverage for the uninsured through the existing private insurance system, funded by a national ad valorem (i.e., sales) tax. I had a long conversation with CAP’s CEO, John Podesta, shortly after it was published, and while John is intellectually honest enough to recognize the advantages of single-payer, his advocacy of the CAP plan was more based on political viability than operational efficiency or effectiveness.

In any case, trying to impose a regressive national sales tax to fund insurance for 47 million people through an expensive, inefficient system not only makes no economic sense, I fail to see how it would be politically attractive, or even politically possible. It would make Democrats look like your daddy’s Democratic Party — you already can hear the Republicans, “Here they go again, another big, costly Democratic welfare program.”

By contrast, a single-payer system could cover everyone, including the 47 million uninsured, at a net cost-savings, as the savings obtained by cutting overhead from 22-31 percent down to 3 percent would more than pay for providing coverage for the 47 million currently uncovered. It makes far more sense to approach healthcare reform as an issue which affects everyone, than it does approaching it as an issue that affects only the poor, to be solved by another welfare program, funded by more taxes — in this case, a regressive tax.

America’s current healthcare system works well for no one, and it would be better to seek a genuine progressive fix on the basis that we’re all in this together and need to find solutions that work for everyone, rather than special pleading for some at the expense of others. The uninsured have to be covered, to be sure, but let’s do it in the context of solving the real problems of American healthcare, not exacerbating the structural problems of the current system.

A System in Collapse

Healthcare is a $2 trillion industry in America, and we are fast approaching a “perfect storm,” where individual consumers, voters, business and the government are beginning to realize the current healthcare system not only is not healthy, it is unsustainable. Is the range of discussion of “serious” healthcare proposals limited to proposals that offer only variations on the failed private insurance model? Howard Dean apparently doesn’t think so.

If progressives are going to project progressive solutions and be part of this debate, they will need to do so quickly because the system is fast-collapsing and decisions are going to be made with or without us.

Guy T. Saperstein is a Democracy Alliance partner and past president of the Sierra Club Foundation; previously, he was one of the National Law Journal’s “100 Most Influential Lawyers in America.”