PNHP

Universal Health for Insurance Companies

Universal Health for Insurance Companies

by DrSteveB
Daily Kos
Thu Mar 01, 2007

Click here for the original post

Last week I outlined the generic components of so-called mandated or mandatory plans. This week we will, with the help of Professor Len Rodberg briefly outline some of specific national proposals that have been in the news lately:

* America’s Health Insurance Plans
* Better Health Care Together Campaign
* Health Coverage Coalition for the Uninsured
* Sen. Ron Wyden with SEIU & Safeway
* Federation of American Hospitals
* John Edwards

What they share is the goall to keep the insurance companies healthy… lets see how that works.

First a note about Len. Len is not only a great guy, but has been involved in numerous progressive health care reforms from numerous single payer plans going back at least to the Dellums bill (look it up), to early promotion of Community Health Centers, to compiling and analyzing of hospital statistics statewide. He is the only Urban Studies professor I know of with a PhD in Physics (seriously).

As we noted last week, “Universal” Health Care is back in the political arena, for the first time since Hillary-care crashed and burned in 1993-1994. This is mostly due to the fact that costs rising far faster than inflation: From 2000 to 2006 health insurance premiums have one up 87%, compared to 20% for overall inflation and 18% for workers earnings. In our primarily employer-based coverage system more companies are either dropping coverage altogether, or raising the amount paid by employees (contributions to premium, copays, deductibles, reduced coverage).

The national average premium cost for employer-provided insurance is now up to $4,024 per year for single coverage and $10,880 per year for family coverage. Compare that to an annual income at minimum wage of $10,300 and the alleged average annual of a Wal-Mart worker of $17,114. If you have to buy your own, even at the reduced group rate that companies get, there’s not much left over for food and housing.

Not surprisingly the numbers of uninsured have been going up dramatically: from 22 million in 1975, we broke 30 million in 1985, 40 million in 1995, and are now around 46-47 million.

So what about those plans…

* The Good News: “Universal health care” is accepted as the goal.
* The Bad News: This is defined to mean using tax dollars to help the uninsured buy private insurance from the existing high-overhead middlemen of the for-profit insurance companies.

1. America’s Health Insurance Plans & Federation of American Hospitals

* – aka: “the private insurance & private hospital protection plan.”
* Expand SCHIP and Medicaid eligibility for very low-income
* Provide federal and state subsidies and tax deductibility to encourage everyone else to buy private insurance
* In other words: Use taxes to cover some more of the poor high risk, then give more tax dollars to the unnecessary middlemen private for-profit industry that eats up 31% overhead, compared to 4-13% achieved in direct plans.

2. Better Health Care Together Campaign

* aka: “The Grand Coalition”
* Members: ATT (big biz), Kelly Services (temp company), Wal-Mart (bigger biz), SEIU & CWA (unions), Center for American Progress
* Principles but no Program:
* a. Quality affordable insurance coverage for everyone
* b. Individuals are responsible for maintaining and protecting their health
* c. Improved value for health care dollar
* d. “Shared Responsibility”: Businesses, government, individuals all contribute. By business they mean both employers and the private for-profit health care industry.
* Widely covered press Conference, but no real specifics.

3. Health Coverage Coalition for the Uninsured

* aka: “The Even Grander Coalition”
* Members: UnitedHealth, Blue Cross & Kaiser (insurers), American Hospital Association, American Medical Association, Chamber of Commerce & National Association of Manufacturers (biz lobbyists), Pfizer (pharmaceutical company), AFL-CIO (well national anyway; many states, councils and locals have been endorsing Conyers HR-676 “Medicare for All”single payer), SEIU (well Stern anyway, many locals endorsing Conyers HR-676 “Medicare for All”, AARP, Families USA (well Pollack anyway; he’s still feeling too burned by 1994)
* Coalition was so “Grand” that they could agree only on:
* a. Expanding coverage as a goal
* b. Expansion of SCHIP
* c. Tax credits for children’s insurance

4. Senator Wyden’s Healthy Americans Act

* aka: “Employer coverage is dying, so let’s kill it faster”
* Supporters: SEIU, Safeway, Families USA
* Eliminate the tax deductibility of employer-based insurance with goal to ends employer-based health coverage.
* Requires individual purchase of insurance
* Transitional payments by employers
* Subsidies to low-income individuals
* Relies on competition between private insurers to contain costs (but unclear how this would happen since no evidence that health insurers work that way… they only compete for who can get the healthy and wealthy).

5. John Edwards Plan

* I give him some credit for at least making a relatively specific proposal.
* but some do call it “individual mandate with a pretty face”
* essentially same as Jacob Hacker plan from Econimic Policy Institute (EPI)
* Interestingly Edward’s also offered a mandate plan when he ran in 2000.
* Employer mandate (“play or pay”)
* Individual mandate with community rating
* Government subsidies for low-income
* Regional purchasing plans (“Health Markets”)
* Choice of Government program (which is DISHONESTLY referred to as single-payer; shame on them) as well as Private Plans.
* Claim: For everyone: Shared responsibility
* Claim: For the fearful: Lets people keep what they have
* Claim: For those worried about cost: Everyone will work together to make the system more efficient
* Claim: For single payer advocates: Individuals and businesses can choose if they want the government plan; if so, the system will “evolve toward a single-payer approach.”
* No cost control!!!
* Requires additional taxes and expenditure above what we pay already
* by comparison: Single-Payer costs about 5% LESS than current expenditures to cover everybody with high-quality coverage and no out-pocket expenses. That what you can do with the $350 Billion in savings by cutting out the 31% bloat of the unneeded middlemen of the private for-profit insurers.

So, once again… What’s Wrong with an Individual Mandate?

Well among other things:

* Will not lead to universal coverage. Comparison to mandatory auto insurance where at least 10% don’t have.
* Enforcement is anti-public health
* Affordable premium vs half-decent coverage: can’t leave private for-profit insurers in the middle and still have both, as Massachussetts is discovering. Feds discovered this when tried to have Medicare Manged Care and privates could not make enough profit and dropped out, until offered 11% higher payments than regular Medicare!
* Employers will drop coverage (“crowd out”) if play or pay cutpoint is set at affordable level.
* Insurance companies resist community rating (same premium rate for everybody regardless of pre-existing conditions or risk) and mandatory coverage(have to take everybody regardless of pre-existing conditions or risk)
* Leaves in place the consumer nightmare of copays, deductibles, exclusions, denials, appeals.
* Expands the complexity (and humiliation) of Medicaid’s humiliation of means testing (not so easy for the majority of workers who are not on straight regular salary; usually require income tax return to be shown).
* Add new layers of bureaucracy such as the “Health Markets”.
* Additional high cost of about $120 Billion in Federal tax money and some unknown still for individuals.
* No cost control, just continuing rising costs!

Len goes on to argue that none of these plans will happen, because:

* They cost hundreds of billions of additional dollars
* They benefit only those with low incomes and those without insurance, who are politically weak.
* Does nothing for the 50% of middle- and lower-income adults who have insurance but still experience serious problems paying medical bills or insurance premiums.
* Does nothing for the people with insurance and still going into bankruptcy. 50% of bankruptcies due to medical bills and 75% of those folks had health insurance.
* Does nothing for the 12-18% of folks who are underinsured.
* They don’t solve any of the problems (especially rising costs) that concern everyone
* None envisions a real structural change.

In the 1940s and 1950s America moved forward with employer-based group health care coverage.

Going backwards to individual purchase of insurance is not the answer.

What is common to these plans is that they identify the wrong problem and then offer the wrong solution:

* Identification of the problem: too many uninsured.
* Their solution: Require everyone to have insurance
* Employers should contribute but not necessarily offer insurance
* Their real mission: Save the private insurers

The problem really is the Private For-Profit Insurance Industry:

* None of these plans does much about what is the real problem
* Excessive administrative costs
* Excessive complexity
* Continuously rising costs
* Lack of coordination, budgeting, and planning
* Regressive financing via premiums (premium is the same if you are rich or poor)
* Widespread underinsurance and bankruptcy
* Interference in physician decision-making
* The “hassle factor”: paperwork at every level, filing claims, automatic or phony denials, re-submitting claims…

Solution:

* Expand Medicare to cover everyone: The hassle difference between folks who use Medicare is astounding.
* Improve the coverage it offers (drugs, dental, mental)
* Eliminate private insurance
* Automatic enrollment in Medicare for All
* Income-based financing through employers and employees (yeah for “shared responsibility”), preferably through progressive income and corporate taxes, but possibly via deduction taxes (e.g., ~8% corporate; ~2.5% on individuals).

For more on how single-payer works: peviously I outlined and described in some depth how single payer works, and debunked some of the myths propagated against single payer.

Something else all those so-called “politically practical compromise plans” have in common.

* They are all are just inside the beltway elites and lobbyists talking to each other (the same ones over and over, as you may have noticed).
* None actually has any grassroots support.
* The one plan with a grassroots movement behind it is Rep. John Conyers HR-676 “Medicare for All”.

HR 676 has been endorsed by over 235 union organizations in 40 states including 60 Central Labor Councils and Area Labor Federations and 17 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO & MN), as have many other civic and religious organizations. Including several locals of SEIU.

The bill garnered nearly 78 co-sponsors in the last Congress, more than any other reform proposal, including the chairman of Ways and Means (Rangel, D-NY) and the chair of Ways & Means health subcommittee (Pete Stark, D-CA). At least three of the newest members of Congress made support for single payer national health insurance a key issue in their campaigns. Senator Kennedy has been the Senate sponsor in past years.

HR 676 would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident: It would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing aids, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

HR 676 has been endorsed by 235 union organizations in 40 states including 60 Central Labor Councils and Area Labor Federations and 17 state AFL-CIOs (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO & MN), as have many other civic and religious organizations.

So, here is what YOU can DO now:

1. Ask your congressperson to sign-up as a co-sponsor of HR-676!

* You can look-up your elected officials here

2. Get any organization you belong to — civic, religious, labor, community, etc. to pass an HR-676 endorsement resolution:

* Here is how to do that via Physicians for a National Health Program.
* or here hereif you prefer via a non-physician group.

Just do it!

The Des Moines Register on mandating private insurance

Mandating private health insurance is misguided

Taxpayer-financed health coverage is a better approach.

By the Register Editorial Board
The Des Moines Register
March 5, 2007

It sounds simple enough: Get everyone insured by requiring them to purchase health insurance. So-called “individual mandates” are part of Massachusetts’ plan to get all residents covered. They are included in a proposal by California Gov. Arnold Schwarzenegger. In a recent conversation about health reform in Iowa, state Sen. Jack Hatch said he supports individual mandates because they inject “personal responsibility” into health care.

But forcing people to purchase private-sector insurance is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate.

Proceeding with this idea would be a mistake.

Just a few weeks ago, this editorial page told the story of Jan and Gary Clausen, who didn’t have the option of buying health insurance through an employer. They went out on their own and bought AARP-endorsed plans for about $700 a month. They were left with more than $200,000 in medical bills after Gary was diagnosed with cancer.

Some insurance.

If the state is going to force people to purchase insurance, it must guarantee necessary services are covered and the bills are paid when health disasters strike. It must require insurance companies to protect Iowans against catastrophic costs.

Of course, that’s where things really get complicated.

Will the state define coverage in private-sector insurance plans? Will it increase oversight of the insurance industry? Will it prohibit insurance companies from increasing prices? What is the definition of “affordable” insurance? Who will qualify for a public subsidy to purchase insurance, and how will that be paid for?

All these questions and more need to be answered.

But our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage.

Private is not better than public when it comes to health insurance.

Private health-insurance companies spend a greater percentage of dollars on administrative costs than government programs such as Medicare. Private companies also use health dollars to pay outrageous CEO salaries. UnitedHealth Group Inc. paid a former CEO $8 million a year. He also had unrealized gains on company stock options totaling nearly $1.6 billion.

Try finding a government worker with a personal jet.

Private-sector insurance has been a financial failure in Medicare Advantage plans, where the government subsidizes insurance companies to take over the care of seniors rather than keeping them in less expensive traditional Medicare.

According to a study by The Commonwealth Fund, Medicare spent $922 more on each senior in private plans than it would have paid to cover those patients in traditional Medicare in 2005. That’s a total of more than 5.2 billion tax dollars that could have been saved or spent elsewhere if seniors would have remained in the basic, government plan.

Why push anyone into the more costly private sector?

A taxpayer-financed system of health care that offers basic coverage for all Americans is a better approach. It would be administered by the government, and it would save money.

According to the National Coalition on Health Care, the nation’s largest alliance working to improve care, a system like this could save 1.1 trillion health-care dollars over 10 years. Of four plans proposed by the coalition, a universal, publicly financed one was the best deal.

Of course, a national system would require those in Washington to get busy solving the problem rather than leaving states to scramble for ways to cover their residents – and pursue misguided ideas like individual mandates.

http://desmoinesregister.com/apps/pbcs.dll/article?AID=/20070305/OPINION03/703050303/1035/OPINION

Comment:

By Don McCanne, MD

This is the message that the nation must hear. The private insurers are incapable of providing us with coverage that is both affordable and effective in preventing financial hardship for those with health care needs.

When an AARP-endorsed plan with a premium of $700 a month leaves a couple with $200,000 in medical bills, we know that private insurance is not the solution. Mandating participation in a fatally flawed system represents the worst of public policy proposals.

This editorial should be downloaded and distributed widely. Everyone needs to understand what will work, and what won’t.

Doctors call on Albany over health insurance

Business First of Buffalo
Monday, March 5, 2007

The New York State Academy of Family Physicians has called on Gov. Eliot Spitzer and the state Legislature to create a single payer health-care system.

Family physicians from across the state gathered in Albany Monday to lobby lawmakers. Their concerns include the fact that nearly 3 million New Yorkers are uninsured and many more are underinsured, while others have insurance that does not cover significant items like medications.

Rising costs have a growing number of employers either dropping or reducing coverage. The doctors also complain that dealing with multiple insurance plans, with their different rules, forms, and procedures, wastes an estimated 20 percent to 30 percent of the health care dollar.

The Academy, which represents about 3,000 family doctors and more than 700 medical students, would like have all payments funneled through a single payer, eliminating multiple rules and procedures, enrollment and eligibility problems.

“A single payer health plan is the best way to control costs and reduce administrative waste and thereby insure long-term survival of universal, affordable coverage,” said Dr. Linda Prine, chair of the Academy’s Commission on Public Health.

“In Albany, the attempts at expanding coverage and cost control, though laudable, only tinker with the current system. The weakness we all witness with tinkering is that New York has achieved neither universal coverage nor
effective cost control. Instead, we are bankrupting ourselves, making small dents only in adding broader coverage, and implementing even more administrative procedures. Moving to universal coverage is a big step. The current system is not working; we should not take a failed system and make it a bigger failure.”

http://buffalo.bizjournals.com/buffalo/stories/2007/03/05/daily4.html

Liberal Fables About Health Care

John Edwards' Big Lie

By CORPORATE CRIME REPORTER
March 6, 2007

When Ann Coulter used the f- word last week to describe John Edwards, she was just trying to sell Ann Coulter to her conservative base.

When Hillary Clinton morphed into a southern black preacher, she was desperately trying to sell Hillary Clinton to a southern black audience.

When John Edwards mailed out 70,000 DVDs advocating “universal health care” to Iowa voters this week, he was just trying to sell John Edwards to the corn belt.

All were scamming the public in pursuit of fame and fortune.

Coulter was her crass and calculating self.

Hillary deserves what that moment bought her.

As for Edwards, as the only avowed “populist” in the race, he wants voters to believe that his health insurance plan will lead to affordable universal coverage.

It won’t and he knows it.

But as a liberal Democrat, his hands are tied.

No liberal Democrat with a shot at the nomination can tell the truth about health care.

Because telling the truth means social insurance, single payer, Medicare for All.

Telling the truth means wiping out private insurance companies and their $350 billion in excess administrative costs–enough to cover the uninsured and underinsured–without paying anymore than we do now.

Today we spend $7,000 per person on health care in the United States–that’s twice as much as the rest of the industrialized nations.

Edwards’ plan is a complex brew of health markets, public incentives and private mandates.

Dr. Don McCanne of Physicians for a National Health Program has one word for Edwards’ plan–“lousy.”

“The idea of setting up a public plan to compete with private plans has been thoroughly discredited,” McCanne told Corporate Crime Reporter. “No matter what regulations are established, private plans will continue to select the healthy–especially the healthy workforce and their healthy families. The private plans cover the majority of us who are healthy and cost very little, while as taxpayers we pay most of the costs for health care for those with medical needs.”

The Edwards plan’s complex mixture of private and public plans will not wipe out the hundreds of millions of dollars in excess administrative costs needed to fund the uninsured.

McCanne believes social insurance–everyone covered by government insurance–is the best system–next to government sponsored medicine–like the Veterans Administration.

McCanne believes the Edwards plan was drafted by Yale University political scientist Jacob Hacker.

“Hacker is the darling of the progressive Democrats,” McCanne told Corporate Crime Reporter. “It is the same as the Edwards proposal. I suspect Hacker wrote the Edwards proposal.”

“Insurance has to do two things,” McCanne said. “In the past, all it had to do was transfer from the healthy to the sick. The medical costs of the sick were paid by the majority of people who were relatively healthy. Now, health care costs are so high that the healthy group can no longer afford the premiums. Now, we need a transfer from the wealthy to average income individuals and then continue a transfer downward. It is this transfer from the wealthy to average and lower income individuals that the Edwards’ fragmented model can’t accomplish.”

The country is bursting at the seams looking for leadership the to usher forth Medicare for All.

Sure, if you are bought into a corporate or government bureaucracy, you might be fine–for now.

In Tucson, Arizona, we ran into a young mother who got a job working part-time at Trader Joe’s just to get health insurance for her family.

But millions of Americans are uninsured and even buying into the system full-time won’t solve their problems.

Recently, a friend told us the story of a father of three in the Rust Belt who was training to be a technician with Comcast.

Comcast promised him 60 hours of work a week. He was really excited. But then he was told–no benefits.

No benefits at 60 hours a week?

How did they pull that one off?

“Well, they told him he would work 30 hours a week as an employee,” my friend related. “And 30 hours a week as a contractor.”

No insurance.

Edwards has a choice.

Reverse course, join the majority of the American people, and speak out for Medicare for All.

Or stick with the insurance industry and lose to the more experienced politicians in the race.

Corporate Crime Reporter is located in Washington, DC. They can be reached through their website.

Groups line up on health plan

Governor's proposal would cost billions

By Robert Manor
Chicago Tribune staff reporter
Published March 6, 2007

Although details of the proposal won’t be known until later this week, interest groups are already starting to take positions for or against Gov. Rod Blagojevich’s plans to expand health insurance to hundreds of thousands of people without medical coverage.

Some business groups don’t like the proposal, in part because it would cost them billions of dollars in new taxes.

The hospital industry likes the plan, in part because it means it would see fewer uninsured patients seeking care but lacking money to pay for it.

Meanwhile, some consumer advocacy groups back the plan as a first step toward insuring at least some of the state’s 1.4 million uninsured. But others say the plan is so complex it won’t work, nor does it go far enough.

“It’s too complicated,” said Dr. Quentin Young, chairman of Illinois Health Care for All and past president of the American Public Health Association. “It’s noble in concept but it is almost certain to fail.”

Blagojevich is expected to announce Wednesday that he supports a new $6 billion tax on corporations, with at least $2 billion going to provide medical coverage to 500,000 Illinois residents and the rest for other state purposes.

The plan is expected to include subsidies so workers could afford health plans. It would be financed by a tax of up to 2 percent on corporate gross receipts and a 3 percent payroll tax on companies that do not offer health insurance, according to early reports.

Insurers would be required to offer a standardized, comprehensive health insurance policy to the uninsured, without regard to existing health problems.

“This is monstrous, the largest tax increase in the history of the state of Illinois,” said David Vite, president of the Illinois Retail Merchants Association.

Vite said a tax on a company’s revenues, which is how he defined a gross receipts tax, is fundamentally unfair. For example, with a 2 percent tax, companies with $10 million in revenue would pay $200,000 a year, whether they were highly profitable, barely breaking even or losing money.

His association, which represents 23,000 retailers, has taken no stance on the idea of expanding health care to the uninsured, Vite said.

“We haven’t taken a position on the governor’s health care proposal because we have not seen it,” he said.

The Illinois Hospital Association, which represents 200 hospitals and health-care systems, is already pushing in favor of Blagojevich’s plan.

Association President Kenneth Robbins said the uninsured miss annual checkups and preventive care. Then they arrive in hospital emergency rooms when ill, often sicker than if they had regular medical attention.

“Many of the problems that the uninsured struggle with could have been prevented had they received the right care at the right time,” Robbins said.

At least one business doesn’t know what to think about the governor’s plan, but is going to study it closely.

“We are in kind of a unique position on this because it affects us not only as an employer but as a provider,” said Michael Polzin, a spokesman for Walgreen Co. “If people have some sort of insurance, they are more likely to get their prescription filled.” Prescriptions are highly profitable to Walgreens.

Polzin said that Walgreens’ 10,000 to 15,000 Illinois employees receive company health insurance if they work more than 30 hours a week.

Some see expanded health insurance, paid for by business, in stark terms.

“I think it’s a big mistake,” said Tom Gimbel, chief executive of The LaSalle Network, a large provider of temporary workers.

He said many employers will react immediately when confronted with higher taxes.

“They will let somebody go,” Gimbel said.

Jenny Wittner, associate director of Women Employed, an advocacy group for the economic advancement of women, wants to know more details about the governor’s plan. “We just know that we are for health care for all,” Wittner said. She noted that the majority of workers in low-wage jobs without health care are women.

And Young, a long-time health-care activist who has pushed for expanded health insurance, sees the governor’s proposal as deeply flawed.

He said Illinois needs to follow the model of Medicare, where the government uniformly provides health insurance to people 65 and over. Illinois should do the same thing, only cover everyone, he said.

“Medicare is a remarkably cost-effective, successful, program,” Young said.

rmanor@tribune.com

Copyright (C) 2007, Chicago Tribune

Editorial: Unions should lead on health

The Capital Times
Madison, WI.
March 6, 2007

The AFL-CIO executive board is this week considering where the labor movement as a whole should line up on health care, which Americans tell pollsters is their No. 1 domestic policy concern. Hopefully, the labor leaders who gather in Las Vegas starting today will follow the lead of the Wisconsin AFL-CIO and go for the bold.

Wisconsin’s state labor federation backs the United States National Health Insurance Act (HR 676), which would establish a single-payer health insurance system with guaranteed coverage for all Americans. Sponsored by U.S. Rep. John Conyers, D-Mich., the act would create a publicly financed, privately delivered health care system by expanding access to the existing Medicare program to all U.S. residents.

Advocates say the goal of the legislation is to ensure that all Americans, regardless of employment, income or health care status, will have a legal guarantee for access to the highest quality and most cost-effective health care services.

Honest measures, from Canada and other developed nations, suggest that a single-payer system is superior to the current U.S. system, which fails to cover 47 million Americans and provides inadequate coverage to a similar number of their fellow citizens.

But Americans do not need to borrow a plan from Canada or elsewhere. As supporters of HR 676 remind us: America already has a great single-payer system, Medicare. It simply needs to be expanded.

In addition to Wisconsin’s federation of labor, state federations in 16 other states have backed HR 676. So too have 63 regional labor councils and hundreds of local unions. Four international unions, including the United Auto Workers, an important player in Wisconsin, have joined the call.

Under Wisconsin AFL-CIO President David Newby, our state federation has been a leader for real health care reform.

Now the national AFL-CIO must become a leader on these issues.

It should do so not for reasons of symbolism or rhetoric. It should do so because, with an election year coming, Democratic candidates for president will be angling for the AFL-CIO endorsement.

The AFL-CIO should sign on for a single-payer system. Then the national federation should in combination with state and local union leaders make it abundantly clear to New York Sen. Hillary Clinton, Illinois Sen. Barack Obama, former North Carolina Sen. John Edwards and others pursuing the Democratic nomination that it is impossible to seek the presidency as a champion of labor without embracing HR 676 and campaigning on a promise to stop tinkering around the edges of the health care crisis and address it head-on.

When he was speaking vaguely the other day about the need for fundamental reform of our health care system, Obama said, “We can’t afford another disappointing charade in 2008, 2009 and 2010. It’s not only tiresome, it’s wrong.”

That’s right. But even Obama has failed to take a bold stand in favor of single-payer.

Labor needs to show Obama the way, just as it must similarly aid Clinton, Edwards and the others in the race for the presidency. The Democratic nominee for president in 2008 must offer us the promise of real reform not just rhetoric. And labor can make that happen.

The Myth of Value-Based Pricing — So Far

BIOTECH


Posting by Donald Light, PhD
Princeton University
Health Affairs blog
February 20, 2007

At last policymakers and readers are being set straight that the prices of drugs are not related to the immense costs of research and development but to “what the market will bear,” as James Robinson put it in his Health Affairs Blog post last fall. Never mind that pharmaceutical executives told Congress and everyone else the opposite for 50 years to wrest government protections from the normal price competition. Apparently we’ve all been duped since the Kefauver hearings over 45 years ago, and industry-supported analysts keep issuing ever higher estimates of $1.2 billion and $1.7 billion R&D cost per average new drug. Since industry data show full recovery of R&D costs, with strong profits, year after year, does this mean these estimates are exercises in false rhetoric?

How can the market know what it will bear if pricing is usually covert and value unknown? Why does the “free market” in the United States result in the highest prices in the world, according to the recent report by the Congressional Budget Office? Do those prices reflect true value? This is impossible because, as Robinson writes, “No one knows how to define value in health care,…much less how to measure it.” Thus biotech and pharmaceutical prices cannot be based on value.

Meantime, the sellers are busy recruiting and supporting health economists to define value, measure it, and produce articles “proving” that the value of their drugs is two to four times greater than current prices. In their hands, the value of a life-year has quadrupled in the past five years, thus inflating the value of products. So far then, “value-based pricing” means the sellers define and measure value, tell us how valuable their products are, and provide the basis for still higher prices.

Is this why Robinson writes that we should not feel sticker shock when companies charge $35,000 per year for Herceptin, $50,000 for Avastin, or $120,000 for Erbitux? We now know that such prices are not based on sunk R&D costs. And we’ve learned they can’t be based on undefined and unmeasured value; so what are these prices based on? Many physicians and patients feel they are based on the exertion of pure power by drug companies who have the drugs that people need.

One common answer by economists is that price is related to expected R&D costs, but then expected costs can be whatever the seller says they are, like the $1.2 billion estimate, which is based on trial costs about 12 times greater than companies report to the IRS in audited statements and trial sizes 4 times greater than independent sources like the FDA. Divide the industry-claimed costs by 12 and then 4 and you get cost-estimates 1/48th as large. For biotech companies and investors, the best indication that future R&D is worth the cost and risk is how rapidly and profitably they recover their past investments in R&D. But that brings us full circle back to what we are told prices are not based on, and it’s a completely different argument than value pricing. More important, pharmaceutical and biotech companies never provide figures to show how prices or revenues are actually related, either to past or future R&D costs. This is the beauty of using theories to describe how reality works! The advantage of economic sociology is that it starts with detailed description and draws empirical conclusions.

For these reasons, “value-based pricing” is a myth, at least so far. To make it a reality we would need at least something like the tables in Consumer Reports Best Buy Drugs. They compare effectiveness, safety and price for different classes of drugs. Take statins for people with a mild cholesterol problem who want to lower their LDL cholesterol less than 30% without changing their lifestyle. Several drugs are rated as equally effective and safe. Patients or their plan could buy Lovastatin 40mg for $58 a month. Or for 59% more they could pay $92 for Lipitor and achieve comparable results. The price for an equivalent supply of Zocor is 79% higher ($104), and for Mevacor the price is 164% higher ($153). But Mevacor 40 is just Lovastatin 40 with a brand name. Apparently the name is worth $95 more.

If we compare how much physicians prescribe each of these five statins, we will get an indication of how far we are from buying on value, even when comparing price and value is simple. Something quite different is going on. It’s time to forget arguments based on theory and look closely at the organization and dynamics of the multi-level, segmented markets involved.

Click here to read Donald Light’s Original Post

Massachusetts redefines "affordable"

Insurers slice rates on health premiums

By Jeffrey Krasner
The Boston Globe
March 4, 2007

Governor Deval Patrick yesterday unveiled significantly lower prices for the health insurance plans that uninsured residents will be required to buy starting July 1.

The annual deductible for the basic plan would be steep: $2,000 for an individual and $4,000 for a family.

Performing a calculation… shows an average monthly premium for residents of Eastern Massachusetts of $305. That indicates a decrease of nearly 20 percent in premiums from the earlier bids.

But each plan offers a range of prices based on age. Plans for young adults with more limited coverage are much less expensive. Residents older than 56 will pay more for coverage. The highest-priced plan for those in Eastern Massachusetts, for people ages 56 to 64 with prescription coverage, is from Blue Cross Blue Shield and has a proposed monthly premium of $504.69.

James Roosevelt Jr., the chief executive of Tufts Health Plan, said… (that) Tufts was able to lower prices in part by limiting its hospital network to those that could provide lower-cost, high-quality care. “For example, for cardiac care, we have Mount Auburn Hospital in Cambridge rather than Massachusetts General Hospital,” Roosevelt said.

http://www.boston.com/business/globe/articles/2007/03/04/insurers_slice_rates_on_health_premiums/?page=full

And…

High deductibles a healthcare worry

By Alice Dembner
The Boston Globe
March 5, 2007

In its attempt to make health insurance premiums affordable, a state board is giving the go-ahead to plans with high deductibles, but that is causing concern that many newly insured people may avoid getting treated when they’re sick or may run up onerous debts to pay their medical bills.

Board officials have said a high deductible is necessary to keep the monthly premiums as low as possible and potentially entice more people to comply with the state mandate to obtain health insurance.

But, research shows high deductibles deter people from getting needed treatment, including preventive care, and can plunge those without savings into debt.

“The state is going to have to make some difficult trade-offs between comprehensiveness of benefits and affordability of coverage, at least in the short-run,” said Nancy Turnbull, president of the Blue Cross Blue Shield of Massachusetts Foundation, which helped shape the universal coverage law. “High deductibles are a blunt and crude way to make coverage affordable. In the future, I hope we can find other ways.”

The new minimal plans are targeted at 160,000 to 200,000 Massachusetts residents without insurance who earn more than $29,400 a year.

John McDonough, executive director of the advocacy group Health Care For All, worries that the board’s proposal could undermine the goal of universal insurance because people “in marginal circumstances” will be “coerced into paying premiums for a policy they won’t be able to use.”

One board member who supports a higher deductible to reduce the premium nonetheless acknowledges it is not ideal.

“It’s not the policy that optimizes health,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who has studied the impact of deductibles. “But, we can’t insist everyone who has no insurance get the policy that optimizes their health. They’re going to revolt.”

“The main thing is no one should be bankrupted by medical costs in Massachusetts,” he added. “Let’s get them into the system and get them real insurance, and then maybe they’ll be interested in buying something better.”

http://www.boston.com/news/local/massachusetts/articles/2007/03/05/high_deductibles_a_healthcare_worry/?page=full

Comment:

By Don McCanne, MD

At an average premium of $305 per month, plus a $2,000 deductible, a person earning $29,400 per year must pay $5,660 before receiving help with medical bills. That leaves less than $2,000 per month to live on. That’s affordable? And don’t even think about receiving care at Massachusetts General Hospital.

The contortions that the policy community goes through to avoid endorsing single payer reform could not be better exemplified than by the comments of Jonathan Gruber, a highly respected MIT economist: “Let’s get them into the system… and then maybe they’ll be interested in buying something better.”

Sure, Professor Gruber.

Massachusetts redefines “affordable”

Insurers slice rates on health premiums

By Jeffrey Krasner
The Boston Globe
March 4, 2007

Governor Deval Patrick yesterday unveiled significantly lower prices for the health insurance plans that uninsured residents will be required to buy starting July 1.

The annual deductible for the basic plan would be steep: $2,000 for an individual and $4,000 for a family.

Performing a calculation… shows an average monthly premium for residents of Eastern Massachusetts of $305. That indicates a decrease of nearly 20 percent in premiums from the earlier bids.

But each plan offers a range of prices based on age. Plans for young adults with more limited coverage are much less expensive. Residents older than 56 will pay more for coverage. The highest-priced plan for those in Eastern Massachusetts, for people ages 56 to 64 with prescription coverage, is from Blue Cross Blue Shield and has a proposed monthly premium of $504.69.

James Roosevelt Jr., the chief executive of Tufts Health Plan, said… (that) Tufts was able to lower prices in part by limiting its hospital network to those that could provide lower-cost, high-quality care. “For example, for cardiac care, we have Mount Auburn Hospital in Cambridge rather than Massachusetts General Hospital,” Roosevelt said.

http://www.boston.com/business/globe/articles/2007/03/04/insurers_slice_rates_on_health_premiums/?page=full

And…

High deductibles a healthcare worry

By Alice Dembner
The Boston Globe
March 5, 2007

In its attempt to make health insurance premiums affordable, a state board is giving the go-ahead to plans with high deductibles, but that is causing concern that many newly insured people may avoid getting treated when they’re sick or may run up onerous debts to pay their medical bills.

Board officials have said a high deductible is necessary to keep the monthly premiums as low as possible and potentially entice more people to comply with the state mandate to obtain health insurance.

But, research shows high deductibles deter people from getting needed treatment, including preventive care, and can plunge those without savings into debt.

“The state is going to have to make some difficult trade-offs between comprehensiveness of benefits and affordability of coverage, at least in the short-run,” said Nancy Turnbull, president of the Blue Cross Blue Shield of Massachusetts Foundation, which helped shape the universal coverage law. “High deductibles are a blunt and crude way to make coverage affordable. In the future, I hope we can find other ways.”

The new minimal plans are targeted at 160,000 to 200,000 Massachusetts residents without insurance who earn more than $29,400 a year.

John McDonough, executive director of the advocacy group Health Care For All, worries that the board’s proposal could undermine the goal of universal insurance because people “in marginal circumstances” will be “coerced into paying premiums for a policy they won’t be able to use.”

One board member who supports a higher deductible to reduce the premium nonetheless acknowledges it is not ideal.

“It’s not the policy that optimizes health,” said Jonathan Gruber, an economist at the Massachusetts Institute of Technology who has studied the impact of deductibles. “But, we can’t insist everyone who has no insurance get the policy that optimizes their health. They’re going to revolt.”

“The main thing is no one should be bankrupted by medical costs in Massachusetts,” he added. “Let’s get them into the system and get them real insurance, and then maybe they’ll be interested in buying something better.”

http://www.boston.com/news/local/massachusetts/articles/2007/03/05/high_deductibles_a_healthcare_worry/?page=full

Comment:

By Don McCanne, MD

At an average premium of $305 per month, plus a $2,000 deductible, a person earning $29,400 per year must pay $5,660 before receiving help with medical bills. That leaves less than $2,000 per month to live on. That’s affordable? And don’t even think about receiving care at Massachusetts General Hospital.

The contortions that the policy community goes through to avoid endorsing single payer reform could not be better exemplified than by the comments of Jonathan Gruber, a highly respected MIT economist: “Let’s get them into the system… and then maybe they’ll be interested in buying something better.”

Sure, Professor Gruber.

Public opinion on health care reform

The New York Times/CBS News Poll
Feb. 23-27, 2007

22. Thinking about the country as a whole, are you generally satisfied or dissatisfied with the cost of health care in this country? Would you say you are very (satisfied/dissatisfied) or somewhat (satisfied/dissatisfied)?

3% – Very satisfied
11% – Somewhat satisfied
22% – Somewhat dissatisfied
59% – Very dissatisfied
4% – DK/NA

24. If you had to say, which do you think is a more serious problem right now — keeping health care costs down for average Americans, OR providing health insurance for Americans who do not have any insurance?

31% – Keeping costs down
65% – Providing for uninsured
5% – DK/NA

25. How serious a problem is it for the United States that many Americans do not have health insurance — very serious, somewhat serious, not too serious, or not at all serious?

70% – Very serious
25% – Somewhat serious
3% – Not too serious
1% – Not at all serious
1% – DK/NA

27. Do you think the federal government should guarantee health insurance for all Americans, or isn’t this the responsibility of the federal government?

64% – Guarantee
27% – Not responsibility
9% – DK/NA

30. If you had to choose, which do you think is more important for the country to do right now, maintain the tax cuts enacted in recent years or make sure all Americans have access to health care?

18% – Cutting taxes
76% – Access to health insurance
1% – Neither
2% – Both
4% – DK/NA

31. Would you be willing or not willing to pay higher taxes so that all Americans have health insurance that they can’t lose no matter what?

60% – Willing
34% – Not willing
6% – DK/NA

37. Do you think it would be fair or unfair for the government in Washington to require all Americans to participate in a national health care plan, funded by taxpayers?

43% – Fair
48% – Unfair
9% – DK/NA

38. Which do you think would be better for the country: 1. Having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, OR 2. Keeping the current system where many people get their insurance from private employers and some have no insurance.

47% – One program
38% – Current system
4% – Combination (vol.)
2% – Neither (vol.)
8% – DK/NA

39. Some people have suggested requiring all Americans to have health insurance. Under this plan, employers would be required to provide insurance for all their workers or pay into a fund that would be used to buy insurance for people who do not have insurance. Does this sound like a good idea to you, a bad idea or are you unsure?

36% – Good idea
17% – Bad idea
46% – Unsure
2% – DK/NA

49. Do you think the government would do a better or worse job than private insurance companies in providing medical coverage?

30% – Better
44% – Worse
3% – Same (vol.)
22% – DK/NA

http://graphics8.nytimes.com/packages/pdf/national/03022007_poll.pdf

Comment:

By Don McCanne, MD

Polls continue to show that Americans are very concerned about the problem of the uninsured and about our high health care costs. They believe that the government should guarantee insurance for everyone, and a clear majority are even willing to pay more taxes to accomplish that.

Although we have decided that the problems are very serious and that they must be fixed, we remain divided as to the appropriate respective roles of the government and the private insurance plans. Especially noteworthy in this poll is the fact that only 30 percent of Americans believe that the government would do a better job than the private insurance plans in providing medical coverage.

This lack of confidence in the government isn’t strictly due to anti-government ideology. To the contrary, 64 percent believe that the government should be involved in guaranteeing insurance for everyone. It is much more likely that that those who are healthy and insured believe that their private health plans will work for them should major problems arise. Although they are concerned about increases in premiums, cost sharing, and reduction in benefits, they have not really given much thought as to how the government could address those issues more effectively. The fact that 48 percent believe that it would be unfair for the government to require all Americans to participate in a national health care plan does demonstrate that there is still concern about making the government the exclusive provider of health insurance.

Privately insured individuals incorrectly assume that most of their health cost spending is for the premiums they and their employers pay and the out-of-pocket expenses for themselves and their families. What they don’t realize is that two-thirds of health costs are being paid through the tax system, though with little transparency. They believe that the private plans are funding much of our health care when the heavy weight is actually being carried by us as taxpayers.

Just to list a few other issues that most people don’t think of when they express a preference for private health plans: profound administrative waste, cost shifting, fragmentation of risk pools, medical underwriting, insurance rescission, lifetime caps on coverage, restricted choice of physicians and hospitals, cream skimming, lack of impact on infrastructure to reduce waste and improve value, inability to provide adequate financial security at affordable premiums, inequitable regressive financing of health care, necessity to perpetuate demeaning and underfunded welfare programs, inadequacies of mandates to purchase private insurance, tax dollars wasted on private Medicare Advantage plans, and… (this list is endless!).

So the decision has been made that we must reform health care. We still need to agree on whether that should be through a universal program of government insurance or through an expansion of our inequitable, wasteful, fragmented system of a multitude of private plans and public programs. Polls such as this are being used to suggest that solutions perpetuating the role of private insurers have greater political feasibility. Thus most proposals accept the deficiencies of private plans, such as those listed above, as a tradeoff for increasing the probability of enacting some type of reform, no matter how flawed. Rather than crafting reform to fit misperceptions, shouldn’t we be attempting to change perceptions to align them with reality?

The ultimate decision may default to the government solution once the policy community wakes up and reframes the problem from the straw man of affordable insurance premiums to the blatantly obvious problem of affordable health care. The private insurers have no solutions for the latter, except to dump the real costs onto the taxpayers. Since we’re already paying those, why should we continue to pay the private insurers so much to merely stand on the sidelines and watch? They disappear when it’s their time to play.

Poll Shows Majority Back Health Care for All

By ROBIN TONER and JANET ELDER
New York Times
March 1, 2007

A majority of Americans say the federal government should guarantee health insurance to every American, especially children, and are willing to pay higher taxes to do it, according to the latest New York Times/CBS News Poll.

While the war in Iraq remains the overarching issue in the early stages of the 2008 campaign, access to affordable health care is at the top of the public’s domestic agenda, ranked as far more important than immigration, cutting taxes or promoting traditional values. Only 24 percent said they were satisfied with President Bush’s handling of the issue, despite his recent initiatives, and 62 percent said the Democrats — not the Republicans — were more likely to improve the health care system.

Americans showed a striking willingness in the poll to make tradeoffs for a better health care system, including paying as much as $500 more in taxes a year and forgoing future tax cuts. But the same divisions that doomed the last attempt at creating universal health insurance, under the Clinton administration, are still apparent. Americans remain divided, largely along party lines, over whether the government should require everyone to participate in a national health care plan, and over whether the government would do a better job than the private insurance industry in providing coverage.

Looking ahead to the presidential campaign, 36 percent of Americans said they had confidence in the ability of Senator Hillary Rodham Clinton, the New York Democrat, to “make the right decisions on health care,” while 49 percent said they were uneasy about it. But Mrs. Clinton, who presents herself as a sadder but wiser candidate on health care, retained the confidence of nearly 6 in 10 Democrats on the issue, despite the politically devastating collapse 13 years ago of the national health initiative she helped develop early in her husband’s presidency.

The poll helps explain why health care already looms large in the presidential campaign, and in statehouses from California, where Gov. Arnold Schwarzenegger, a Republican, has proposed a sweeping coverage plan, to Massachusetts, now implementing a program passed under Mitt Romney, the former governor and current Republican presidential candidate. Nearly 47 million Americans, or more than 15 percent of the population, now go without health insurance, up 6.8 million since 2000.

Former Senator John Edwards of North Carolina, the Democratic presidential candidate, recently unveiled his own attempt at a consensus plan — requiring everyone to have insurance and requiring employers to provide it or pay into a fund that would do so. Nearly 4 in 10 said that was a good idea; nearly half said they were unsure.

While Democrats are traditionally strong supporters of expanding health coverage, this survey found many Republicans and independents in agreement.

“I think everybody should have some kind of health care available to them,” said Diane Manning, 66, of Vancouver, Wash., who described herself as an independent.

“I don’t necessarily think that socialized medicine is the answer, but I think everyone should have that right,” said Ms. Manning, who participated in the poll and agreed to a follow-up interview “And there are so many people that don’t.”

The poll also found overwhelming support behind the Childrens’ Health Insurance Program, which covers many low and moderate income children and is up for renewal in Congress this year. Eighty-four percent of those polled said they supported expanding the current program to cover all uninsured children, now estimated at more than eight million. A similar majority said they thought the lack of health insurance for many children was a “very serious” problem for the country.

The nationwide telephone poll was conducted Friday through Tuesday with 1,281 adults, and has a margin of sampling error of plus or minus 3 percentage points.

The poll found Americans across party lines willing to make some sacrifice to insure that every American has access to health insurance. Sixty percent, including 62 percent of independents and 46 percent of Republicans, said they would be willing to pay more in taxes. Half said they would be willing to pay as much as $500 a year more.

Nearly 8 in 10 said they thought it was more important to provide universal access to health insurance than to extend the tax cuts of recent years; 18 percent said the tax cuts were more important.

“I wouldn’t want to pay a lot of taxes, but if it was spread out and everyone paid their fair share, it would be fine,” said Don Galvan, 50, a computer programmer from Ringwood, N.J., who considers himself an independent. “Everybody should have some kind of medical coverage, in case they or their children get sick. Especially children.”

Most Americans in the poll said they were satisfied with the quality of their health care, but there was widespread concern about costs. Nearly half of those with insurance said their employer had cut back on benefits or required them to pay more for their benefits in recent years. A quarter of those with insurance said someone in their household had gone without a medical test or treatment because insurance would not cover it. Six in 10 of those without insurance said someone in their household had gone without care because of the cost.

That level of concern helps explain the striking support for substantial change: Nearly two-thirds said the federal government should guarantee health insurance for all Americans. They were then asked, “What if that meant that the cost of your own health insurance would go up?” Forty-eight percent said they would still support it.

Moreover, an overwhelming majority said the health care system needed either fundamental change or to be completely rebuilt, just as they did in the early 1990s, when a deep recession and soaring health care costs galvanized the public and spurred the Clinton health care drive. But now, as then, this concern did not translate into a consensus on what should replace it.

One question offered a choice between the current system and a national health insurance program covering everyone, administered by the government and financed by taxpayers. Thirty-eight percent said they preferred the current system, while 47 percent preferred a government-run approach.

Nearly half said they thought it would be unfair to require all Americans to participate in a national health care plan, financed by taxpayers.

Robert Blendon, an expert at Harvard on public opinion and health, said politicians have to find some compromise between these philosophical divisions on the role of government, which are deep-seated in American culture, or “We’re going to have the same train wreck we did before.” The Clinton plan, itself an attempt at a compromise, collapsed under the weight of attacks from an array of interests, including the insurance industry, which warned that it amounted to a big government takeover.

Mr. Blendon noted that many politicians, like Mr. Schwarzenegger, were seeking a blend between the private market and the government in their health plans.

Marina Stefan and Marjorie Connelly contributed reporting.