PNHP

Get real! (by proper framing)

Get real! (by proper framing)

The Way I see It: The author makes a case for a shift to a consumer-driven system.

By Jordan L. Geller, MD
Medical Economics
December 15, 2006

There’s another problem with calling healthcare a right. It imposes an obligation on the government to fulfill that right–something our government is neither economically nor functionally equipped to do. In contrast, the Bush administration reform plan would shift at least part of the healthcare burden from employers and government back to the consumer. By coupling a high-deductible policy with a tax-free health savings account, policy makers believe that Americans will become more efficient and discerning consumers of healthcare.

The devil is in the details, of course. Still, if the current plan accomplishes anything, it will almost certainly raise anew the question of health and individual responsibility. This is crucial for progress in the area of healthcare reform, since, to date, the bad effects on health of certain lifestyle choices–poor diet, overeating, smoking–have done little to alter peoples’ behavior. If, on the other hand, consumers were forced to shoulder more of the financial burden of their lifestyle choices, finally, perhaps, they’d be motivated to pursue healthier choices.

Comments from our readers:

dmccanne / San Juan Capistrano, CA
Posted Dec 15 2006

The wealthiest nation of all is not financially equipped to do what all other industrialized nations have – insuring everyone? And the fear of spending money from a health savings account is a greater incentive to quit smoking than the fear of cancer, heart disease or emphysema? Get real! We each have a personal responsibility to take care of ourselves, but we also have an egalitarian responsibility to our fellow Americans to see that financial hardship does not compound the misfortune of illness or injury.

http://www.memag.com/memag/article/articleDetail.jsp?id=390156

And…

Building on the Progressive Victory

By George Lakoff
Rockridge Institute
December 15, 2006

What is a progressive worldview? It’s simple: You have empathy for others, and you act responsibly on that empathy, being both responsible for yourself and socially responsible as well. Progressives say, “We’re all in this together” while conservatives say,” You’re on your own.” It was running on those progressive values that won the election for the Democrats.

Progressive values-based reframing has begun to work, because it has been paired with authenticity (saying what you believe) and with framing that highlights the very real traumas affecting the nation.

The role of the progressive activists, grassroots, and netroots is to promote progressive values to biconceptuals both within and outside the Democratic party — to activate the progressive beliefs they already have and to extend them further by speaking a progressive language and using progressive values, ideas, and arguments. The goal is not just to move the Democrats in a more progressive direction, but to move Republicans and independents in that direction as well. The idea is to benefit the nation, not just the party.

And conservative values and practices, when they lead to people getting hurt and our democracy undermined, have to be attacked overtly.

This election marked a progressive victory and a victory for progressive efforts at factually accurate, values-based framing.

http://www.rockridgeinstitute.org/research/lakoff/building-on-the-progressive-victory

Comment:

By Don McCanne, MD

Berkeley linguistics professor George Lakoff has taught us much about framing. In the example from Medical Economics, I have applied some of his concepts:

1) Do not let the opponents frame the debate.

2) Establish your own framing that accurately communicates the principles you wish to express.

3) Be meticulous in maintaining the credibility of your framing.

4) When the opponents’ framing is not credible, do not hesitate to briefly expose their lack of credibility for the purpose of destroying their frame.

In the example, Dr. Geller has linked together, in a single frame, dismissing the role of government in health financing and relying on individual responsibility. Without entering his framing of rights and responsibilities, we have destroyed his credibility by exposing his fallacies – that the United States is not “economically equipped” for the task, and that personally assuming the financial burden of health care incredibly improves health, when all of the data is to the contrary.

Our framing much more credibly establishes two separate frames – one for personal responsibility, and the other for egalitarian responsibility.

Although Professor Lakoff’s message has been a call for progressives to catch up with the conservatives on framing, it is also a nonpartisan message. Let’s establish a highly credible frame for the health care reform debate within which we can all communicate. And let’s overtly attack those who would undermine the process.

For more on George Lakoff and the Rockridge Institute:
http://www.rockridgeinstitute.org/people/lakoff

Can we learn from Oregon?

Health Reform Interrupted: The Unraveling Of The Oregon Health Plan

by Jonathan Oberlander
Health Affairs
December 19, 2006

Abstract:

The Oregon Health Plan (OHP) has received national and international attention for rationing medical care based on explicit priorities. However, in recent years OHP has lost substantial enrollment and struggled to live up to its core principles. This paper explores what went wrong in OHP and the implications of Oregon’s experience for state-led health reform.

Lessons for state health reform (excerpt):

The strongest challenge to sustainability, though, may come from rising medical costs. As medical inflation increases, and with it the number of uninsured people who lose employer-sponsored coverage and qualify for public insurance, the price tag for maintaining–let alone broadening–coverage expansions also increases, and retrenchment may supplant activism on the agenda. And as Medicaid spending consumes a higher percentage of state budgets, outpacing revenue growth and threatening to crowd out spending for education and other politically popular priorities, ambitious plans to cover the uninsured become more difficult to fulfill. Economic downturns exacerbate these pressures, especially since states must live with balanced budget requirements. Cost control, which triggers intense opposition from medical-industry interests that profit from the status quo, requires much more political will to impose than insurance expansions do. Avoiding cost control and gaining the support of system stakeholders is perhaps the key to short-term political success. However, its absence may be, in the long run, the Achilles’ heel of state-led health reforms that seek to move toward universal coverage without serious mechanisms to control spending in their own programs and without limits on medical care inflation in the broader health system.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.1.w96

Comment:

By Don McCanne, MD

There are many factors involved in the unraveling of the Oregon Health Plan that will not be discussed here, but most are of importance to other states. Nonsubscribers can download this article free of charge for the next two weeks and should do so to learn these other important lessons from Oregon. Only one factor will be discussed here.

The most difficult problem that Oregon and all other states have faced is the continuing escalation of medical costs. Now that there seems to be a growing political consensus that comprehensive reform must occur at the state level, we need to ask whether the states would be capable of stabilizing the system by controlling costs.

We can’t discuss controlling costs without understanding some of the more important reasons for our high costs. Amongst them are deterioration of our primary care infrastructure, high prices, profound administrative inefficiencies, and an excess of non-beneficial high-tech services.

Innumerable studies have demonstrated that a strong primary care infrastructure ensures the delivery of higher quality care at a lower cost. Could any state build that infrastructure independently? It would require a transformation of both our medical education and health care delivery systems to achieve that mission. It is unlikely that any one state would be capable of that intrinsically, not to mention the fact some states might expropriate the products of the efforts made by other states. We will not have an effective primary care infrastructure until we have made it a national policy that all concerned individuals and institutions cooperate in efforts to build the primary care system we need.

Our health care pricing is the highest of all nations. Could any one state independently control prices, whether through markets or by government control? Both government and private insurance programs already set rates, yet health care costs continue to escalate. Prices need to be set based on legitimate costs and fair profits. The most efficient and equitable method would be through negotiation. If one or two states acted independently without other states involved in a similar process, cost shifting and unfair pricing would be inevitable with the possible consequence of instability in the health care delivery infrastructure. We need national policies to establish a system of pricing that is fair for all.

Much of the administrative waste that characterizes the health care system in the United States is due to the fragmented financing system of public programs and a multitude of private plans. Could a state independently establish an efficient, coordinated system of health care financing, such as a single payer system? It would be impossible without federal involvement. The state would require funds that are currently financing Medicare, Medicaid, SCHIP, and innumerable other programs that have designated revenues flowing to the states. Even though administration would be more efficient on a state or regional basis, only the federal tax system has the size and stability to ensure that state programs remain adequately funded. We need federal policies to be sure that adequate public funds would always be available for an administratively efficient financing system.

Can states control the high-tech excesses? Once again, that would require a coordinated effort between our medical education and health care delivery systems. Only a national resource such as the National Institutes of Health would be capable of providing the parameters to guide this process. We need federal policies to support national programs that would identify value in all health care services, not just high-tech, so that we receive greater relative benefit from our health care expenditures.

The Democrats have indicated that they intend to merely tweak our system. Many are advancing programs to shift responsibility to the states to allow them to adopt “politically feasible” programs that have been designed by the conservatives. (One important factor in Oregon’s unraveling was the introduction of “personal responsibility” through decreased benefits and greater cost sharing.)

Oregon, and every other state for that matter, have provided us with an important lesson. The states cannot act alone. It must be national policy that everyone has access to comprehensive, high quality, affordable health care.

All state programs have fallen short. Why do we continue these experiments with state laboratories when a simpler, single national health insurance program will do it?

Would Europe's health-care-for-all model work here?

Cover everyone and use Medicare as a model

The Press-Enterprise
December 17, 2006

The perspective of Don McCanne, senior health policy fellow, and Nicholas Skala, research associate, Physicians for a National Health Program

Compared to other advanced nations, the United States spends far more on health care but achieves only mediocre results. Though the World Health Organization has ranked us first in spending, we are ranked 37th in performance–well behind Canada and all Western European nations. What do these countries know that we don’t?

Universal coverage is public policy in the rest of the industrialized world, but it is not in the United States. We leave nearly 47 million without any insurance at all. Even the insured are finding that increasingly inadequate private insurance policies are leaving them exposed to insurmountable costs.

Although unheard-of in other nations, illness and medical bills contribute to half of personal bankruptcies here, and 75 percent of those with medical debt had coverage when they got sick.

How do other nations insure everyone, protect their personal assets from medical debt and do it at a much lower cost than that of the United States? Although no two nations have identical programs, none has adopted the disorganized, wasteful, fragmented insurance payment system that we have in America.

In nations such as the United Kingdom, the government owns the health care delivery system, and it is the direct provider of care. Other nations use a social insurance model in which care is paid for either
directly through the government or via tightly organized and regulated nonprofit companies, while doctors and hospitals remain independent.

These social insurance programs cover everyone, protect against financial losses, more effectively pool risks and fund the entire system much more equitably than we do in the United States.

This egalitarian social insurance model of other nations contrasts sharply with the market model of private plans that we have here. Private insurance companies erect massive bureaucracies for the purpose of fighting claims, issuing denials and screening out the sick from coverage.

Their principal product is an excess of administrative services with its resulting headaches. Doctors, hospitals and businesses must react by employing armies of administrators to deal with this massive private bureaucracy.

Health-care administration consumes a mind-boggling 31 percent of our health spending. Some $350 billion of this waste could be recovered and is enough to extend good coverage to all Americans. Americans are already paying for national health insurance — we just aren’t getting it. Two-thirds of our health-care system already is funded through the tax system.

Although it works well for our armed forces and veterans, Americans may have difficulty accepting a government-operated medicine system similar to the U.K.’s. But we are already comfortable with the concept of social insurance: Our Medicare and Social Security programs are familiar examples.

The public’s response to recent threats of privatization has shown just how protective we are of these programs, even though they are government programs. A national health-insurance system for the United States — in essence “Medicare for All” — would likewise be successful and popular.

Medicare is not perfect. It requires continual oversight and maintenance. But with appropriate revisions, it can serve as an American model of comprehensive coverage for everyone.

While making funding more equitable, the system can assure care will remain affordable. Even though the Europeans provided us with the health-policy science, we can take pride in the fact that Medicare is our own, made-in-America idea.

http://www.pe.com/localnews/opinion/localviews/stories/PE_OpEd_Opinion_D_op_1217_mccanne_loc.c79484.html#

The opposing view, “Beware massive costs, rationing, loss of freedom,” was written by Grace-Marie Turner of the Galen Institute and Robert E. Moffit of The Heritage Foundation. Their op-ed was not posted on The Press-Enterprise website, but an unedited version is available from Galen:
http://www.galen.org/healthabroad.asp?docID=950

The opposing view that was posted on The Press-Enterprise website, “Government-run systems restrict care,” was written by Merrill Matthews of the Council for Affordable Health Insurance:
http://www.pe.com/localnews/opinion/localviews/stories/PE_OpEd_Opinion_D_op_1217_matthews_loc.c79387.html

Comment:

By Don McCanne, MD

Would Europe’s health-care-for-all model work here? Since no two European nations have the same model, the question really is whether an insurance program that covers everyone would work in the United States. Since we already spend far more per capita on health care than the European nations, there is absolutely no doubt that a properly designed universal insurance program would work as a “health-care-for-all” model (or Medicare for All).

Grace-Marie Turner, Robert Moffit, and, separately, Merrill Matthews didn’t answer that question, but, in their usual reframing of the debate, they changed the topic to rationing. So their question is whether the level of rationing that would take place in the United States would be so severe that we should not attempt to cover everyone with effective insurance. In their response they ignored two crucial points.

Those European nations that have been attentive to capacity and have practiced queue management do not have significant problems with excessive queues. At our level of spending, there would be no need to ration reasonable, beneficial health services, though we should reduce funding for non-beneficial or detrimental services. But that is not rationing; that is value purchasing – a feature of well functioning health systems.

The other point is that they remain silent on the nation with the worst rationing of all – the United States. We ration care for tens of millions of Americans based strictly on their ability to pay. A national health insurance program would eliminate that inhumane basis for rationing.

In our debate over health care reform we don’t need more anecdotes about C-T scans for dogs, or ideological discussions about freedom to pay for your own health care. We need serious discussions about policies that will work. Unless the opponents come up with something better than national health insurance, they should get out of our way and let us heal our very, very sick system.

Change players or rules?

Commercial Health Insurance: Smart Or Simply Lucky?

By Marsha Gold
Health Affairs
November/December 2006

Rapid growth in health costs threatens to reduce coverage and financial protection by making health insurance increasingly expensive. Policy-makers who perceive that they can rein in the rapid growth in spending within public insurance programs such as Medicare and Medicaid by transferring responsibilities to commercial health insurers will be disappointed. Analysts comparing historical growth in per capita spending for Medicare and private insurance between 1970 and 2000–when the former was mainly a government-run program and the latter was provided by commercial health insurers–found that, on average, the private sector grew no more slowly than Medicare and in fact grew faster on some measures. It is a serious mistake to assume that the cost problems plaguing our health system can be solved by changing the players rather than the rules of the game.

http://content.healthaffairs.org/cgi/content/full/25/6/1490

Comment:

By Don McCanne, MD

In commenting on the move of commercial insurers into our public programs – Medicare and Medicaid – Marsha Gold has made it clear that cost problems will not be solved by merely changing the players when the rules of the game need to be changed.

Since cost issues are not limited to our public programs but involve our entire health care system, it is clear that none of the players are globally effective, and that the rules absolutely must be changed. But when you think about the new rules that we need, the commercial insurers, as we know them, will be utterly incapable of playing by those rules.

We not only need to change the rules, but we need to change the players by substituting the one single player we need – single payer.

Lewin Group analysis of Sen. Wyden's plan

Cost and Coverage Estimates for the “Healthy Americans Act”

Prepared By: John Sheils, Randall Haught, Evelyn Murphy
The Lewin Group
December 12, 2006

(The Healthy Americans Act is a bill being introduced by Sen. Ron Wyden of Oregon.)

Executive Summary (excerpts):

The “Healthy Americans Act” (HAA) establishes a centrally financed system of private health insurance for all Americans except those covered through Medicare or the military. Participants would chose from a selection of private plans offered through newly created regional purchasing organizations called “Health Help Agencies” (HHA’s). All Americans would have coverage at least as comprehensive as the health coverage now provided to members of Congress and federal workers, although an actuarially equivalent substitution of HMO and Health Savings Account (HSA) plans is permitted.

Employers would be required to “cash-out” their health plans by terminating their existing health coverage and paying the amount saved to their workers in the form of increased wages. The current tax exemption for employer provided health benefits is eliminated to strengthen incentives for families to seek lower cost coverage. However, a new “health premium” tax deduction is created so that these wage increases do not increase federal personal income tax payments. To maintain incentives to control costs, the deduction is fixed and can not be increased by purchasing more costly coverage.

All HAA participants would pay premiums through their annual income tax filings. The program would fully subsidize the premium for those below 100 percent of the federal poverty level (FPL), with the premium phasing-in for people living between 100 percent and 400 percent of the FPL. People who do not have enough income to pay taxes are assumed to be eligible for the program with full subsidies, thus eliminating the need to apply separately for assistance as under the current Medicaid program. Employers also would be required to pay an assessment ranging from 2 to 25 percent of the national average premium for the minimum benefits package, depending upon firm size and revenues per worker.

E. Private Employer Impacts (excerpts):

Private employer health spending under the HAA is reduced under the HAA by $309.8 billion, from $428.8 billion under current law to $119.0 billion under the program.

We assume that the savings to employers would be passed-back to workers in the form of increases in wages. This reflects the HAA requirement that employers “cash-out” their benefits plans. It also reflects economic theory and research indicating that changes in employer benefits for health care are, in the long run, passed back to workers in the form of wages or some other form of compensation such as pensions or disability insurance.

This reflects that the employer’s true cost of employing workers includes all compensation costs including: wages less employer payroll taxes, health benefits, pensions, and other non-cash benefits. In competitive labor markets, eliminating the health benefits (or any other form of compensation) would bid-up other forms of compensation such as wages so that aggregate compensation levels are largely unchanged.

http://wyden.senate.gov/Healthy_Americans_Act/HAA_Cost_Coverage_Report.pdf

Sen. Wyden’s plan (with links to the Act and other documents):
http://wyden.senate.gov/media/2006/12132006_Healthy_Americans_Act.htm

Comment:

By Don McCanne, MD

Sen. Wyden’s proposal is an individual mandate to purchase private health plans. Much has been written about the flaws of such models, and no attempt will be made to address most of those issues here. Rather only one serious fundamental flaw in the application of economic theory will be discussed.

The theory is that in competitive labor markets, total compensation is determined by the market, but the distribution between payroll and other benefits such as health plans and pensions does not influence the total compensation. Thus termination of a health benefit program results in an increase in wages that has the same monetary value.

In Sen. Wyden’s proposal, not only does it assume this theory to be true, it also provides back-up enforcement by requiring that employers increase wages by the same amount of the health benefit that will be terminated under this Act, but only for the first two years. After that, the competition of labor markets resumes, but without the complication of a health benefit program. Employees are on their own for accessing and funding their health plans.

Whether through union efforts or in the open job market, compensation is negotiated, at least theoretically. That includes wages and often health benefits and pensions. It does not include food. It does not include housing. It does not include transportation. It does not include any other basic needs. Those needs fall under the category of personal responsibility – use your wages wisely to meet those needs.

Now health care is shifted away from being considered as part of the compensation package, over into this realm of personal responsibility.

Have wages kept up with the costs of basic needs? There certainly has been a redistribution from wage earners to the wealthy. The minimum wage has not been increased for many years. Consumer debt continues to expand. Personal savings are now a negative. Personal insolvency continues to grow. Yet employers are not providing wage increases that are indexed to food, nor to housing, nor to transportation. Now that they are no longer in charge of health coverage, they will feel no obligation to index wages to health costs either.

The Lewin report contends that price competition between health plans, and greater administrative efficiencies will lower costs significantly. If the consolidated efforts of employers have been unable to control costs and waste, how can individual purchasers ever expect to exert market pressures to achieve these efficiencies?

The last section of the Act list many other potential sources of cost savings. Reading the list, the savings potential for many is simple rhetoric, not supported by fact. Some of them would actually increase costs. The Act excludes more effective cost measures such as those of the single payer model.

The point is that costs will continue to increase and wage earners will have to face those costs alone. Employers will have divorced themselves from the problem and will not make an exception for health care anymore than they already do for food, housing and transportation.

Wyden’s plan falls apart since it depends on price competition of health plans, which in turn depends on shifting more unaffordable costs directly to those who need care.

The shocking extent of underinsurance

Changes in Financial Burdens for Health Care National Estimates for the Population Younger Than 65 Years, 1996 to 2003

Jessica S. Banthin, PhD; Didem M. Bernard, PhD
JAMA
December 13, 2006
JAMA. 2006;296:2712-2719.

Context: Policymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients.

Objective: To estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care.

Design, Setting, and Population: Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out- of-pocket expenditures for health care services, including premiums.
Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income.

Main Outcome Measures: Total and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003.

Results: In 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with nongroup coverage, aged 55 to 64 years, living in a non– metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage.

Conclusions: Our analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies.

Author Affiliations: Division of Modeling and Simulation, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Md.

http://jama.ama-assn.org/cgi/content/abstract/296/22/2712?etoc

Comment:

By Don McCanne, MD

Not more numbers! Don’t we have enough to make the case for national health insurance?

These numbers are important. Let’s see if we can make some sense of them.

This study indicates that the financial burden on families of medical costs has continued to grow worse. We should look at the most recent year studied, 2003, to get a better idea of the extent of the problem as we experience it today.

This is not a study of the numbers of uninsured (we already know those numbers), nor is it a study of the numbers with inadequate insurance or underinsurance (we don’t know those numbers). Rather, it is a study of the numbers of individuals under 65 who experienced financial hardship in a single year because their health care costs were greater than our health care financing system was capable of protecting against. It is not a study of the potential risks, but rather it is a study of actual financial harm done.

Most can agree that spending more than 10% of family income on health care constitutes a financial hardship, except perhaps for the very wealthy. So how many individuals experienced this hardship in one year – 2003? 48.8 million individuals, or 19.2% of our population!

One-fifth of all Americans! If you were to average that out, that means that everyone of us would have a year of financial hardship due to medical bills within the next five years, and every five years. Of course, disease is not evenly distributed, so those who remain healthy will not have a problem, but those with medical disorders will have multiple years of hardship.

Spending 20% of family income would certainly be disastrous for almost all of us. How many individuals spent that in 2003? 18.7 million or 7.3% of our population! That’s a disaster!

Well let’s forget about the uninsured for a minute and look at those of us who have insurance. Let’s not even count the insurance premiums that we or our employers are paying, but let’s look exclusively at the out-of-pocket expenses that we are paying for health care. This will give us a better idea of just how well our insurance is working.
How many paid more than 10% of family income for health expenses not covered by their insurance? Of those younger than 65, 17.1 million individuals! Underinsurance is a national epidemic that engulfs many more everyday!

There are some very important numbers from the tables in the article that do not appear in the abstract above.

What percent of middle-income Americans spent more than 10% of family income on health care? The answer? 22.7%!! That is almost as much as the 23.7% of low-income families that spent over 10% on health care. Health care costs are not just a problem for the poor, they are very much a problem for middle-income America!

One very small number from the charts may say the most about our flawed system of financing health care. What percent of high-income Americans spent more than 20% of their incomes on health care? One- fifth of their high incomes is a lot of money. Well, it was only 0.6% But think about that. One out of every 167 high-income Americans had to spend over 20% of their incomes on health care. If our health care financing system cannot reliably protect the wealthy, then it is a flawed system indeed.

Maybe the wealthy don’t care. The chances are 166 out of 167 that they won’t experience major medical debt in any given year, and they will likely outlive those odds. But middle-income Americans should be very, very afraid!

Insurance broker fraud

Only wreckage remains when insurance agents breach trust You think you're covered? You might be surprised, and at the worst possible time.

By Mark Morris
The Kansas City Star
December 11, 2006

Insurance agent misconduct and fraud is widespread and getting worse, according to experts interviewed by The Kansas City Star.

Among the most common abuses: agents who steal a client’s premiums by failing to forward them to the insurance company. Bad agents also sell unlicensed products or coverage that is unsuitable. And some are just crooks, no better than a policyholder who commits insurance fraud.

“A disturbing and growing number (of agents) won’t hesitate to bilk their own clients in order to pad their own lifestyle or bail out an agency that’s in trouble,” said James Quiggle, a spokesman for the Coalition Against Insurance Fraud, a nationwide advocacy group supported by insurance companies, regulators and consumer groups.
“It’s a front-and-center problem for regulators all over the country.”

To be sure, most agents are honest, according to experts who have studied the insurance industry.

http://www.kansascity.com:80/mld/kansascity/16210675.htm

Comment:

By Don McCanne, MD

Health care injustice is not only tragic, it is also infuriating when it is due to criminal misdeeds of entrusted advisors. But the problem of dishonest insurance agents is negligible compared to the problems inherent in the way individual plans are marketed and sold. It is the honest, ethical agents who are trying to do their best for their clients who are the real problem, though through no fault of their own.

Insurance agents have a difficult task. They must help their clients purchase plans that are affordable, that provide adequate financial protection, that will cover preexisting disorders, that will ensure that providers are accessible, and they must be certain that the insurer is reliable and capable of assuming risk. Truth told, there are no health insurance products that meet all of these standards. So the agent is in a position of assisting his/her client in selecting a compromised product, and may not even be able to provide any product if costs are prohibitive or medical underwriting prevents coverage.

Insurer administrative costs are already outrageous, yet the insurance agents add still another layer of pure administrative costs that provide no medical benefit. Under our fragmented system of financing health care, the services of an agent are essential whether that function is performed by an independent agent or an agent of the insurance company. It’s simply more waste. But worse, the need for competitive premiums results in products that fall short on the goals of comprehensive, affordable coverage for any and all applicants.

What we need is a single insurance product that covers all reasonable, beneficial services, and one in which enrollment is automatic for everyone for life. We wouldn’t need brokers to help us do that if we had a single payer program of national health insurance.

Robert Gumbiner on single payer

A Solution to America’s Health Care Crisis: Curing Our Sick Health Care System

By Robert Gumbiner, M.D., with Alis Gumbiner

I am proposing the federal government as the single payer of health care in this country. Only the federal government has the ability to fund one large risk pool through a payroll deduction. As the single payer, the federal government could negotiate hospital and physician payments even more effectively than it does now with Medicare. In addition, the federal government could negotiate prices for prescription drugs.

A single pool of funds, collected and administered by the government, would expand Medicare and replace Medicaid, SCHIP, the Veteran’s Administration, and private health insurance, including the health care aspect of Worker’s Compensation Insurance. Also eliminated would be the tax credit – or subsidy – given to companies for providing private health insurance to their employees. In other words, the current, inefficient patchwork of payment systems would disappear, to be replaced by one nationwide program available to every citizen.

http://www.healthcarecure.org/

Comment:

By Don McCanne, MD

What is remarkable about this quote in support of single payer is its source: Robert Gumbiner was the founder of FHP, one of the nation’s largest managed care companies.

Dr. Gumbiner received fame (some might say infamy) for his innovations in developing systems that controlled health care costs. In his book, he describes his successes and failures, and his evolving thoughts about how to best address the problem of affordability, currently the nation’s leading concern about health care. His bottom line is that we must enact a national single payer program, and that conclusion is coming from a manager’s perspective.

No funds for children's insurance, only for HSAs for the rich

Congress Punts on Children’s Health Care in Favor of Tax Shelter for Wealthy Statement of Robert Greenstein, Executive Director

Center on Budget and Policy Priorities
December 7, 2006

It is stunning that as one of its final acts, Congress chose to attach to the tax extenders bill a provision making Health Savings Accounts more lucrative as tax shelters for wealthy individuals even as Congress refused to provide funds needed to ensure that up to 600,000 low-income children keep their health insurance through the State Children’s Health Insurance Program in 2007.

It has been known all year that without additional SCHIP funding, 17 states would face SCHIP shortfalls in 2007. The Administration included a proposal in its budget to address these shortfalls.
Various bills to resolve the problem were introduced in Congress. But when decision time came, Congressional leaders declined to act.
Coverage for up to 600,000 low-income children will be at risk as a result.

When it came to making HSAs more lucrative as tax shelters, by contrast, Congressional negotiators charted a different course. They took a special-interest HSA bill that had never been considered on the floor of either the Senate or House and attached it to the same bill to which they declined to attach the needed SCHIP resources.

To say this is disappointing would be an understatement. Congress has provided another windfall for Uncle Scrooge — and a lump of coal for Tiny Tim.

http://www.cbpp.org/12-7-06health-stmt.htm

Background on SCHIP shortfall:
http://www.cbpp.org/6-5-06health2.htm

Background on HSA expansion:
http://www.cbpp.org/9-26-06health2.htm

Comment:

By Don McCanne, MD

Is this really the message that voters sent Congress last month?

Inside Track: An Irreverent Read on Vermont Politics

by Peter Freyne
Vermont Political History
12.06.06
Seven Days

Health Care Reform Hero? — Full disclosure: This writer admits to being an AARP member. Aging gracefully. That means we get the magazine. And the latest edition, which arrived last Thursday, was a hot one!

It had nothing to do with actor Robert DeNiro on the cover. It had everything to do with the full-page photo of Vermont Gov. Jim Douglas inside. Seated in blue business suit and red tie, the Green Mountain guv was surrounded by a half-dozen Holsteins.

Face it, the guy is on a roll. GOP Jim just won a third consecutive term at the top in the land where America’s left shines the brightest with the likes of Bernie Sanders, Patrick Leahy and Howard Dean, the Democratic party chairman.

The Vermont governor, along with actors DeNiro, Marlo Thomas and David Hyde Pierce, was chosen by AARP for a 2007 IMPACT Award as one of “10 People Who Make the World a Better Place.”

What a life! How does he do it? In leftist, Democratic/ Progressive Vermont, how does a Republican who supported Richard Nixon as a Middlebury College senior and Vermont House candidate in 1972, and George W. Bush in 2000 and 2004, keep winning elections in Vermont, year after year? And guess what Douglas won the AARP IMPACT Award for? Sitting down, are you?

Vermont’s Gov. Douglas was recognized for his leadership on health-care reform! Hello?

Writes veteran New York magazine writer Joe Treen for the January/February 2007 edition of AARP, which bills itself as the “World’s Largest Circulation Magazine”:

. . . in May, after two years of negotiations, Governor Jim Douglas signed groundbreaking legislation that makes affordable health insurance available to everyone in the state. The new universal health care law, considered the most progressive in the country, also includes a series of cost-saving reforms. It is particularly important in the Green Mountain State, which has 61,000 uninsured citizens and a growing senior population. While the bill was clearly a bipartisan effort, much of the credit goes to Douglas, 55, for refusing to give up. “This was such a key issue,” he says. “The need was so great in terms of containing costs and providing coverage to uninsured Vermonters that we just couldn’t fail.”

Yes, indeed. There’s no business like show business, is there? A few other AARP readers in the Green Mountains couldn’t believe it, either. One was Bruce Cunningham of Hinesburg. Bruce has been an independent advocate and Statehouse regular for decades. His issues include antismoking and underage drinking. OK, a bit of a health nut. Nothing wrong with that, right? He gave Joe Treen a call at his New Jersey residence.

Cunningham told yours truly he politely informed the AARP freelancer that he had gotten the story on the IMPACT award-winning Vermonter terribly wrong. That anyone in Vermont could tell him Gov. Jim Douglas’ real impact was as the leading opponent of health-care reform.

Cunningham later told “Inside Track” that Treen “seemed very happy to talk to me.” Heck, one senior citizen to another, right? None of us is getting any younger.

“He also sounded appreciative of my pointing out that Gov. Jim Douglas was mainly an obstructionist,” said Bruce. “My overall impression was that [Treen] was interested in finding the truth.”

Cool.

We let the weekend pass and then gave him a call on Monday. Joe Treen appears to be a successful magazine-writing pro and, indeed, sounded like a decent baby-boom-generation kind of guy when we gave him a jingle.

However, he wasn’t exactly exuding enthusiasm for getting the story right. Rather, Ol’ Joe was a bit defensive.

Treen told “Inside Track” that after getting the call from Cunningham he “went back and re-looked at the story to make sure it was not off the mark.”

By that he meant he was not considering Gov. Douglas’ veto of the landmark health-care reform bill the Democrats and Progressives passed in 2005. He was only focusing, he said, “within the narrow focus of 2006.” Republican Gov. Jim Douglas may have vetoed reform in 2005, but in 2006, argued Treen, “he kept negotiators at the table.”

By the way, Treen didn’t come to Vermont and did not speak to the Vermont reform advocates.

One of those is “Vermont Health Care for All” activist Deb Richter M.D. Dr. Deb said she first howled in disbelief when she saw that AARP gave our guv a national award for his leadership on health-care reform.

“Is that a scream?” she asked.

But once Richter, like others, got over the initial shock, it made perfect sense to her. Perfect sense, that is, for AARP to find Jim Douglas so likable.

After all, the insurance industry has no greater friend in Vermont than our Republican governor, who, if he had his way, would open Vermont’s borders to every last cherry-picking one of them. In fact, close your eyes, and Jim Douglas could turn into a friendly insurance salesman in about two seconds flat!

As it is, Americans pay the highest portion of earnings of any workforce in the modern world on health care and for-profit health insurance. That’s because in the good ol’ USA, there’s a big fat layer of cost added to our medical bills in order to keep the insurance companies happy. It’s called profit.

“Does it surprise you,” asked Dr. Richter, “that AARP would endorse someone who keeps the insurance industry in good health?” Remember, she pointed out, “AARP sells health insurance.” Lots of health insurance. And AARP “stands to gain billions” from the “4 percent kickback” they get from the Medicare Part D portion of every insurance policy they’ll sell.

Good point, eh?

The modest, watered-down 2006 legislation that the Democrats defend as progress, and the guv won the big award and the big reelection for signing, “was a temporary solution for some folks. I wouldn’t begrudge that,” said Dr. Richter. “The point is, they had the opportunity to do something even bigger. The tragedy,” she told “Inside Track,” “is the fact that they stopped the conversation with this bill.”

And that may be its greatest accomplishment of all — stopping the health-care reform conversation. Congratulations, Guv. Well done!

“For some of my patients,” said Richter, “this will be a good thing. But the problem is, the other 95 percent, who have unbelievable premiums and high co-pays and deductibles, are left hanging.”

OneCare single payer video

OneCareNow.org

Teams in more than 365 California cities are conducting grassroots educational and public awareness “action” events–one event per day, in a different city, for one year–to demand quality, affordable healthcare for all Californians.

http://www.onecarenow.org/index.html

Comment:

By Don McCanne, MD

The OneCareNow campaign is designed to inform the citizens of California about the advantages of single payer reform and Sen. Sheila Kuehl’s legislation to enact it. Although SB 840 was vetoed by Gov. Schwarzenegger, it will be re-introduced in the next legislative session.

The OneCareNow campaign has produced a 22 minute video explaining the advantages of single payer reform. The video is of value not only for Californians, but for the entire nation in that it describes the imperative for a single payer solution, albeit from the California perspective.

The video, The Healthcare Solution: California OneCare, can be viewed on YouTube at the following link (save this link to share with others):

http://youtube.com/watch?v=jB0Vn_BppwM