PNHP

Healthcare-NOW Calls "National Healthcare Action Day" June 7th (6-7-06)

Healthcare-NOW Calls "National Healthcare Action Day" June 7th (6-7-06)

June 7th (6-7-06)

Healthcare-NOW, a national coalition of community, faith based, and labor groups has called for local actions on June 7th in support of HR 676 the “United States National Health Insurance Act” introduced by Congressman John Conyers (D-Mich). The date was chosen to correspond with the bill’s number, HR 676.

Coast to coast actions include picketing Blue Cross offices (Pittsburgh), press conferences outside the offices of the two remaining Massachusetts congressmen who are not yet co-sponsors of the bill (Boston), a news conference to announce a campaign to get eight city councils to endorse HR 676 (St. Louis), noon rally in Rodney Square in Wilmington, DE, plus leafleting, the showing of a specially made video “Don’t Be A Chicken” and much more in communities across the country.

To find the action near you, obtain the video, or a complete list of nationwide activities, go to www.healthcare-now.org or call 1-800-453-1305.

HR 676 now has 70 congressional co-sponsors in addition to John Conyers, Jr. (D-MI). It would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident.

HR 676 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, 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.

#30#

HR 676 has been endorsed by 143 union organizations including 25 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

For further information and a complete list of union endorsers contact:
Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com.

Study: Canadians Healthier Than Americans

By MIKE STOBBE
Associated Press Writer
May 30, 2006, 10:53 PM EDT

ATLANTA — You can add Canadians to the list of foreigners who are healthier than Americans. Americans are 42 percent more likely than Canadians to have diabetes, 32 percent more likely to have high blood pressure, and 12 percent more likely to have arthritis, Harvard Medical School researchers found. That is according to a survey in which American and Canadian adults were asked over the telephone about their health.

The study comes less than a month after other researchers reported that middle-aged, white Americans are much sicker than their counterparts in England.

“We’re really falling behind other nations,” said Dr. Steffie Woolhandler, a co-author of the Canadian study.

Canada’s national health insurance program is at least part of the reason for the differences found in the study, Woolhandler said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.

James Smith, a RAND Corp. researcher who co-authored the American-English study, disagreed. His research found that England’s national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.

“To me, that’s unlikely,” he said of the idea that universal coverage explains international differences.

Woolhandler said her findings were different in at least one important respect: In the Canadian study, insured Americans and Canadians had about the same rates of disease. It was the uninsured Americans who made the overall U.S. figures worse, she said.

The study, released Tuesday, is being published in the American Journal of Public Health. It is based on a telephone survey of about 3,500 Canadians and 5,200 U.S. residents in 2002-03. Those surveyed were 18 or older.

The results are based on what those surveyed said about their health. In contrast, the researchers in the American-English study surveyed participants and also examined people and conducted laboratory tests on them.

The new study found that 6.7 percent of Americans and 4.7 percent of Canadians reported having diabetes; 18.3 percent and 13.9 percent, respectively, reported having high blood pressure; and 17.9 percent and 16.0 percent said they had arthritis. The Americans also reported more heart disease and major depression, but those difference were too small to be statistically significant.

About 21 percent of Americans said they were obese, compared with 15 percent of Canadians. And about 13.5 percent of the Americans admitted to a sedentary lifestyle, versus 6.5 percent of Canadians. However, more Canadians were smokers — 19 percent, compared with about 17 percent of Americans.

About 42 percent of the Americans rated their quality of health care as excellent, while 39 percent of Canadians did.

Also, 92 percent of American women said they had a Pap test within the last five years, while 83 percent of Canadian women had. But Canadians have lower death rates from cervical cancer. “It’s a little hard to interpret,” Woolhandler said.

One more plus for the Americans: Fewer than 1 percent said they were unable to get needed care because of long waits, compared with 3.5 percent of Canadians.

However, about 80 percent of Americans had a regular doctor, while 85 percent of Canadians did. And nearly twice as many Americans said there were medicines they needed but couldn’t afford (9.9 percent versus 5.1 percent).

Copyright 2006 Newsday Inc.

Study shows U.S. residents are less healthy, less able to access health care than Canadians

EMBARGOED UNTIL: May 30, 2006 – 4:00 PM EST

Contacts: Steffie Woolhandler, M.D. 617-497-1268, 671-312-2766
David Himmelstein, M.D. 617-665-1032, 617-312-0970
Nick Skala 312-782-6006

U.S. residents are less healthy, less able to access health care than Canadians

Universal coverage appears to reduce healthcare inequalities

A study by Harvard Medical School researchers in the July, 2006 issue of the American Journal of Public Health finds that U.S. residents are less healthy than Canadians. Moreover, despite spending nearly twice as much per capita for health care, U.S. residents experience more problems getting care and more unmet health needs.

The study analyzes the Joint Canada-U.S. Survey of Health, the first-ever cross national health survey carried out by the two nations’ official statistics agencies. The authors found that U.S. residents were less healthy than Canadians, with higher rates of nearly every serious chronic disease examined in the survey, including diabetes, arthritis, and chronic lung disease. U.S. residents also had more high blood pressure (18% of U.S. residents versus only 14% for Canadians). U.S. rates of obesity and sedentary lifestyle were higher; with 21% of U.S. respondents reporting obesity versus 15% of Canadians. However, U.S. residents were slightly less likely to smoke.

Canadians had better access to most types of medical care (with the single exception of pap smears). Canadians were 7% more likely to have a regular doctor and 19% less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9% of U.S. respondents couldn’t afford medicine vs. 5.1% in Canada). After taking into account income, age, sex, race and immigrant status, Canadians were 33% more likely to have a regular doctor and 27% less likely to have an unmet health need. For each of these measures, the average Canadian did about as well as insured U.S. residents.

Race and income disparities, although present in both countries, were larger in the U.S. Nonwhites were more likely than whites to have an unmet health need in the U.S. (18.6% vs. 11.1%); while in Canada they were not (10.8% vs. 10.2%). Notably, both white and non-white Canadians had fewer unmet health needs than white U.S. residents. After taking into account income, age, sex, race and immigrant status, poor U.S. residents (making less than $20,000 per year) were 2.6 times less likely to have a regular doctor than the affluent ( those making $70,000 or more). In Canada, the poor were only 1.7 times less likely.

In the U.S., cost was the largest barrier to care. More than seven times as many U.S. residents reported going without needed care due to cost as Canadians (7.0% of U.S. respondents vs. 0.8% of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4% reported having an unmet health need due to cost.

Lead author Dr. Karen Lasser, primary care doctor at Cambridge Health Alliance and Instructor of Medicine at Harvard commented, “Most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures. But we found that waiting times affect few patients, only 3.5% of Canadians vs. 0.7% of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada. Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down.”

“These findings raise serious questions about what we’re getting for the $2.1 trillion we’re spending on health care this year,” said Dr. David Himmelstein, Associate Professor of Medicine at Harvard and study co-author. “We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live 2 to 3 years longer.”

Dr. Steffie Woolhandler, also an Associate Professor of Medicine at Harvard and study coauthor, commented: “Our study, together with a recent study showing that people in England are far healthier than Americans, is a terrible indictment of the U.S. healthcare system. Universal coverage under a national health insurance system is key to improving health. It’s striking that both whites and non-whites do better in Canada. A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. How much longer must we wait?”

The study used data from the Joint Canada/U.S. survey of Health (JCUSH), conducted jointly by Statistics Canada (the Canadian counterpart to the U.S. Census Bureau) and the U.S. National Center for Health Statistics. The JCUSH surveyed 3,505 Canadians and 5,183 U.S. residents between November 2002 and March 2003 in order to gauge health status, rates of illness, behavioral risk factors, use of health care, and access to health care services in the two counties.

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Embargoed copies of the study are available to the press at: https://pnhp.org/canadastudy/
(Please call 312-782-6006 or email nick@pnhp.org for password)

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

Read the study (pdf)

PDF version of press release (pdf)

USW's Gerard Speaks on Union Action, Single Payer Health Care and HR 676

Link: http://www.dc37.net/news/radioshows/radioshows.html

We are pleased to be able to make available a far reaching talk by Leo Gerard, International President of the United Steelworkers (USW) delivered May 18th in New York City at an event sponsored by the Central Labor Council and other progressive organizations.

Gerard’s speech, “The Labor Movement and United Action for Health Care for All,” is an important statement by the leader of America’s largest industrial union.

A shortened version of the full speech was broadcast on the weekly radio show of AFSCME District Council 37 produced by Ken Nash on WNYE.

HR 676 has been endorsed by 141 union organizations including 24 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

For further information and a complete list of union endorsers contact:
Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com.

The World Bank report on health financing

Health Financing Revisited: A Practitioner’s Guide
The World Bank
May, 2006

This report provides an overview of health financing policy in developing countries. It is a primer on major health financing and fiscal issues, intended to assist policy makers and all other stakeholders in the design, implementation, and evaluation of effective health financing reforms. The health sector is an extremely complex one, and reformers must be prepared to deal with its complexities when designing and implementing health policy reforms.

Learning from high-income countries

High-income countries have a rich history of health financing reforms as their systems have evolved from community-based voluntary insurance arrangements to formal public insurance funds to social or national health insurance-based financing systems. Nearly all high-income countries, with the exception of the United States, have achieved universal or near universal health coverage. The tax-financed systems have been in place for some time, the social insurance systems more recently. Political will was critical to achieving universal coverage, along with economic growth. As most high-income countries have achieved universal coverage, recent reform activities have tended to focus on efficiency gains through purchasing arrangements, rather than on revenue collection and pooling.

Although high-income countries operate in very different contexts from low-income countries, their experiences furnish some lessons for lower-income countries:

* Economic growth is the most important factor in the move toward universal coverage.

* Improved management and administrative capacity is critical in expanding coverage, as is strong political commitment.

* For low- and middle-income countries transitioning to universal coverage, general revenues and social health insurance contributions are the two principal sources of public funding. Both accumulate public revenues into one or several pools. Because the critical issue is pooling, whether a social health insurance or national health service system is ultimately chosen is of secondary importance.

* Voluntary and community-based financing schemes can serve as tests for countries as they seek to expand the role of prepaid health coverage schemes.

* Broader risk pooling mechanisms, instead of fragmented, smaller risk pools, can contribute significantly to effective and equitable financing of health coverage.

Products and services must be evaluated for their effectiveness and cost-effectiveness within the context of particular countries’ coverage systems. To facilitate the affordability of such efforts, cooperation among similar countries should be encouraged, possibly led by one or more international organizations.

http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTHSD/0,,contentMDK:20200211~menuPK:376811~pagePK:148956~piPK:216618~theSitePK:376793,00.html

Comment:

By Don McCanne, M.D.

As developing countries design and implement their health financing policies, they can learn from high-income countries… “with the exception of the United States.”

How to keep young adults uninsured

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help
By Sara R. Collins, Cathy Schoen, Jennifer L. Kriss, Michelle M. Doty, and Bisundev Mahato
The Commonwealth Fund
May 2006

Young adults (ages 19 to 29) are one of the largest and fastest-growing segments of the U.S. population without health insurance: 13.7 million lacked coverage in 2004, an increase of 2.5 million since 2000.Young adults often lose coverage under their parents’ policies, Medicaid, or the State Children’s Health Insurance Program at age 19, or when they graduate from high school or college. Nearly two of five college graduates and one-half of high school graduates who do not go on to college will be uninsured for a period during the first year after graduation. Three policy changes could extend coverage to uninsured young adults and prevent others from losing it:
extending eligibility for Medicaid and the State Children’s Health Insurance Program beyond age 18; extending eligibility for dependents under private coverage beyond age 18 or 19 regardless of student status; and ensuring that colleges and universities require full- and part-time students to have insurance, and that they offer coverage to both.

http://www.cmwf.org/usr_doc/Collins_riteofpassage2006_649_ib.pdf

Comment:

By Don McCanne, M.D.

It has long been recognized that young adults are the largest and fastest growing group of the uninsured. As a result, policymakers in public and private sectors have been adopting changes designed to expand coverage of young adults. Some of those efforts have been identified in this report, and they include the specific policy recommendations listed.

Although we recognize that these policies would increase coverage, converting them into action on a widespread basis has been and will remain elusive. If you doubt that, look at the recommendations again and decide what rules and regulations you would need, how they would be enforced, and how they would be funded. Confirming the difficulties encountered, efforts to date to adopt these incremental changes have resulted in an INCREASE of 2.5 million in the numbers of uninsured young adults.

Incremental efforts have already been tested, and they have failed. Only fundamental structural reform will accomplish our goal of equitably-funded, comprehensive coverage for everyone. Policymakers need to abandon the path of incrementalism that is leading us to more uninsured, greater medical debt, and more barriers to care. A single payer program of national health insurance is the obvious solution. Can’t the policymakers find that path?

Health care reform lesson from Hungary

Health care reform to follow Socialist model until 2008
Hungary Around the Clock
May 23, 2006

Health care will operate in line with the Socialists’ plans until late 2007, when the Free Democrats’ preferences will take priority, according to an agreement outlined to the media on Monday by Free Democrat chairman Gábor Kuncze.

He said the ground work for converting to a competitive health insurance system will be completed by late 2007. The coalition parties will then examine whether everything is in place for introducing the Free Democrat model of several competing health insurers. The two parties have agreed to convert the National Health Insurance Fund into a shareholding company.

Kuncze said the coalition parties are working to build a system in which it will be irrelevant whether the state or private capital operates the health service. The essence, he said, is that patients will receive a higher standard of health care.

There are also plans to base health care contributions and service packages on a three-tier health insurance system. Patients will be protected against what Népszabadság calls the “jungle” of market competition by an insurance supervisory body.

http://www.caboodle.hu/index.php?id=12&no_cache=1&tx_ttnews%5Btt_news%5D=698&tx_ttnews%5BbackPid%5D=11&cHash=8cab2a67df

Comment:

By Don McCanne, M.D.

Market competition? Several competing health insurers? Private capital? Three-tier health insurance system? Converting the National Health Insurance Fund into a shareholding company?

As Hungary surveyed the various health care models in other nations, they decided to adopt the U.S. model – the most expensive, least efficient, least equitable, and most wasteful system of all, but one that richly rewards the private insurance industry.

The lesson from Hungary is that a democracy requires an informed plebeian input. Failing that, the government could fall into the hands of individuals who cater to those with money and power, such as those who have mastered the process of diverting health care funds away from health care. That scenario is all too familiar to us in the United States.

Whose fault is this? Our citizens will never fully understand the benefits of a publicly-funded and publicly-administered insurance program until we tell them. Let’s not be part of the problem by remaining silent.

What do the affluent believe about health care?

Citigroup Smith Barney
Affluent Investor Poll
May 17, 2006

The cost of health care is a major concern for affluent investors, more so than quality of care available perhaps because investors believe they will bear the brunt of on going drug and insurance costs while they discount the probability of being subject to an on going need for doctor and hospital care. The national health care issues of greatest concern are the cost of prescription drugs, the cost of health insurance, and the cost of long-term care (with about half of all investors saying they are very concerned about each of these issues). Only about one in four express strong concern about the quality of care provided by doctors or hospitals.

Health insurance companies, pharmaceutical companies, lawyers, and the federal government all share some of the blame for what investors see as the problems in the nation’s health care system, with the largest shares naming attorneys (23%) and the federal government (21%) as most responsible. The most affluent group of investors are noticeably less likely than others to assign blame to health insurance companies or pharmaceutical companies, and are noticeably more likely to say that lawyers are a major contributor to the problems in the health care system.

Vast majorities would support any type of change to the current health care system, with most saying they strongly favor the idea of malpractice limits (56% strongly favor), allowing small companies and individuals to join together to purchase health insurance at better group insurance rates (69%), and allowing low and middle income workers to deduct the cost of health insurance premiums from their taxes (50%). Nearly as many favor easing restrictions on imported prescription drugs and establishing tax incentives for those who use high deductible health plans.

Affluent investors were also asked about the health insurance reform recently passed in Massachusetts, in which all citizens are required to have some type of health coverage. While two out of three overall express support for this type of plan, the most affluent do not necessarily feel that way. Those who have assets of $1 million or more are more likely to oppose this idea (46%) than they are to support it (43%).

http://www.smithbarney.com/pdf/pollMay06.pdf

Comment:

By Don McCanne, M.D.

Since the wealthy have greater political influence, it is important to understand their views of our health care system and its reform.

It is not surprising that affluent investors are not well informed on the problems with our health care system, as their biased views reflect those that are prevalent in the pages of the Wall Street Journal and other similar resources.

What is clear is that, like the rest of us, they do want affordable access to comprehensive care. The solutions they support fail to address the real cost drivers and will leave them facing ever escalating costs. Those costs will not be contained until we agree to adopt structural reform of health care funding that addresses the actual inefficiencies and waste in our system.

The problem is that the affluent do not know what they do not know. It is our task to educate them on the real problems and the various policy approaches available. It just happens that the most effective policies that would achieve their goal of health care value are the same policies that would achieve our additional goals of universality, comprehensiveness and equity. They need to understand that.

UAW's Gettelfinger Again Calls for Single Payer Health Care

It’s time for nation health insurance
Ron Gettelfinger, President United Auto Workers (UAW)
The Detroit News, Friday, May 5, 2006

U.S. needs to fix crisis and stop sticking millions with medical debt

You’ve probably noticed more media attention than usual focused on America’s dysfunctional health care system during the past several days thanks to “Cover the Uninsured Week,” an initiative of the Robert Wood Johnson Foundation.

“Cover the Uninsured Week” is a uniquely American event-uniquely American because the United States is the only advanced industrialized nation without some form of universal health care coverage.

Why? The conventional wisdom, of course, is that we can’t afford it. Well, the conventional wisdom is just plain wrong. It’s not that we don’t have the money; it’s that we’re spending our health care dollars inefficiently and foolishly.

America’s foolish spending

With its patchwork health care system, the United States spends a higher proportion of its gross domestic product or total economic output and far more per capita on health care every year than any other industrialized nation. In fact, America’s health care bill of about $5,267 per capita is nearly two and a half times the industrialized world’s median of $2,193.

Yet for all that spending, some 46 million Americans-including more than 8 million children-don’t have any health insurance and an estimated 16 million more are underinsured.

What’s more, despite having the best doctors, nurses and other health care professionals in the world, the United States ranks near the bottom among industrialized nations on life expectancy, infant mortality and virtually every other measure. In fact, the infant mortality rate in our nation’s capital is more than double the infant mortality rate in Beijing.

Most of us would agree that nothing is more valuable than our family’s health. But the harsh reality is that a large and growing number of lower- and middle-income working Americans are forgoing preventive care and putting off medical treatment because they can’t pay for both health care and basic necessities like food, housing, gas and electricity.

Medical debt grows

A newly released study by the Commonwealth Fund found that slightly more than one in five of all working-age Americans, both uninsured and insured, have medical debt they are paying off over time. Nearly one in four uninsured adults say they had used up all their savings to pay medical bills.

The Commonwealth Fund survey also found that nearly three in five uninsured adults with chronic conditions like asthma or diabetes didn’t fill a prescription or skipped taking their medications because they couldn’t afford them. And, not surprisingly, uninsured Americans are far less likely than their insured counterparts to get mammograms and other cancer screenings, dental exams, blood pressure and cholesterol tests, and other preventive care.

The situation is nearly as bad among underinsured Americans.

Treatments get delayed

A recent survey by the Reader’s Digest found that among underinsured middle-class Americans (defined as having household income of $25,000-$100,000, health insurance and deducted medical expenses on their 2004 federal income tax return), about half say they’ve put off or refused medical treatment for a serious condition, or delayed taking or renewing prescription drugs. Nearly one-fourth say they’re behind on medical bills-and nearly half have used credit cards to meet health care costs.

How much worse can it get? Some health care experts predict that if insurance premium increases continue to outpace growth in wages and income, 56 million Americans-including 27.8 percent of working Americans–will be uninsured by 2013, just seven years from now. And those of us fortunate enough to have coverage (and jobs) will be faced with higher premiums, co-pays and deductibles.

There’s a better way

But isn’t there a better way? Of course.

The UAW has long advocated single-payer national health insurance as the fairest and most cost-efficient way to provide affordable, quality, comprehensive health care to every American regardless of income.

Sound impossible? It shouldn’t. We already have more than 40 years experience with a single-payer system in America. It’s called Medicare, and it may not be perfect, but it sure works better than the privatized part of our health care system.

Medicare provides model

Medicare spends nearly 98 percent of its funds (our tax dollars) on actual medical care. In contrast, as economist Paul Krugman noted in his recent New York Times column, Aetna, one of America’s largest health insurance companies, “spends less than 80 cents of each dollar in health insurance premiums on actually providing medical care.”

The rest goes to profits, marketing and administrative costs-including screening out people likely to have big medical bills. In short, health insurance is one area where a government program has proven not only fairer but more cost-effective than the private sector.

National health insurance made sense when President Harry Truman proposed it in 1948. Today, it may be the only sensible way to fix America’s health care crisis.

___________________________________________________

Distributed by:
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com.

The price of insurance

Amid War, Troops See Safety in Reenlisting By Faye Fiore
Los Angeles Times
May 21, 2006

(Staff Sgt. Matthew Kruger) looked around the job market, and it didn’t take long to figure out that leaving the Army held its own perils. Nothing offered him the financial security of his military job – especially the generous health coverage for his wife and three small children.

“We had nothing. We were scared,” (his wife) Maggie said recently… “We suddenly realized there was no way to take the kids to the doctor or dentist for any little reason, as we had been used to.”

For Kruger, who returned to a war zone for his third tour in December, the danger of losing his family’s health insurance was more real and immediate than the danger of dying in combat.

http://www.latimes.com/news/nationworld/nation/la-na-enlist21may21,0,3414020,full.story?coll=la-home-headlines

Comment:

By Don McCanne, M.D.

…. (silence)

Medicare Advantage plans often shift costs to the sick

Medicare Beneficiary Out-of-Pocket Costs: Are Medicare Advantage Plans a Better Deal?
By Brian Biles, Lauren Hersch Nicholas and Stuart Guterman
The Commonwealth Fund
May 2006

(Medicare Advantage) plans may be able to provide more benefits than traditional fee-for-service Medicare because the Medicare Modernization Act included provisions that set MA payments greater than per capita fee-for-service costs in every county in the nation. These extra payments to MA plans averaged over 11 percent ($800 per enrollee) in 2005.

The analysis reported here indicates that the benefit packages offered by MA plans often result in substantial out-of-pocket costs for beneficiaries in poor health: in more than 20 percent of the MA plans we examined, located all across the nation in 15 cities in 10 states, enrollees in poor health would have had greater out-of-pocket costs in 2005 than if they had been in traditional fee-for-service Medicare with Medigap Plan F. If not for the extra payments provided to MA plans across-the-board, this pattern could have been even more pronounced.

Even with the completion of the transition to fully risk-adjusted MA payment rates and planned improvements in the risk adjustment methodology, the incentives for plans to avoid enrollees in poor health are unlikely to disappear. Moreover, as increased pressure to control Medicare spending makes continuation of the current level of extra payments to MA plans more difficult to justify, the incentive to shift costs from healthy to sick enrollees will become stronger.

Issue Brief:
http://www.cmwf.org/usr_doc/927_Biles_MedicarebeneOOPcosts_MA_ib.pdf

KFF webcast:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1743

Comment:

By Don McCanne, M.D.

The cruelest mechanism of containing health care costs is to increase out-of-pocket spending for those with the greatest health care needs. It is shocking to see that many of the private Medicare Advantage plans, in spite of being granted extra payments by the government, are shifting more of the costs to sick enrollees than they would have to pay in the traditional Medicare with Medigap program, despite the well-documented shortcomings of Medigap coverage. In contrast, the Medicare Advantage programs have lower out-of-pocket costs for their targeted market – healthy Medicare beneficiaries who use few services.

In the KFF webcast on the release of this report, Karen Ignagni, president and CEO of America’s Health Insurance Plans, supported repeal of the lock-in to allow patients the freedom to “vote with their feet” whenever their plans displeased them. Obviously, the greater success the plans have in placing a financial burden on sicker patients, the quicker they would exit thereby relieving the plans of the need to cover them.

Private health plan strategy is, and always has been, to insure the healthy and dump the sick. The private Medicare Advantage plans are no different.

And for this the taxpayers are rewarding them with extra payments?! Enough!!

Mandating Cover Tennesee insurers to bear all risk for $150per month

State Senate strikes blow to Cover Tennessee
By Tom Humphrey
Knoxville News Sentinel
May 16, 2006

As proposed by (Gov. Phil) Bredesen, Cover Tennessee would provide a $50 per month state subsidy toward group health insurance for people who have no coverage now and who earn less than 2.5 times the federal poverty level, which works out to $24,500 per year for a single person and $50,000 for a family of four.

The plan would be available to small businesses – those with less than 50 people – that do not offer coverage to employees now. Under the plan, the average employee would pay $50 per month, the state would pay $50 a month and willing employers would pay $50 per month. If employers decline, the individual would pay $100.

The state would solicit bids from major insurance companies and select the one offering the best available insurance package for $150 a month.

The Republican-controlled Senate voted 17-14 along party lines for (Sen. Jim) Bryson’s amendment, which declares that insurance companies would bear all risk of financial losses in operating the program.

“This plan is going to be risky,” Bryson said. “This amendment says we’re not going to take on the risk. (Without it) we run the risk of having another TennCare situation. This will force the plan to be self-sustaining.”

(Finance Commissioner Dave) Goetz said major insurance companies have told him that making them liable for any and all losses means they will not bid on the contract. That will be true especially in the startup year, he said, since there are some uncertainties in going with a new program of limited coverage at relatively low cost.

“It kills Cover Tennessee,” said Goetz after the vote. “Insurance companies will not bid and will not participate if they have to cover all the risk.”

http://www.knoxnews.com/kns/politics/article/0,1406,KNS_356_4701509,00.html

An update from The Tennessean (5/18/06):

A compromise was reached when a House amendment put 2010 as the date when contractors would assume any risk – giving state officials and insurance companies time to see how the plan evolves.

http://www.tennessean.com/apps/pbcs.dll/article?AID=/20060518/NEWS0201/605180408

Comment:

By Don McCanne, M.D.

There are two important policy issues here.

This proposal perpetuates the fiction that making health insurance premiums affordable will make health care affordable. A $150 monthly premium cannot begin to cover comprehensive services and would leave the beneficiary exposed to unaffordable out-of-pocket expenses if a significant medical need were to arise. Even a $50 to $100 per month premium would be a hardship for those earning under $24,500 per year.

The second issue is that private insurers quite understandably no longer want to accept the risk of catastrophic health care losses. They do so only if they can control spending through contracting of provider rates, limitation of benefit coverage, and shifting more out-of-pocket expenses to the beneficiaries. But then they do so only if the premium structure is actuarially sound. Asking an insurer to bear all risk for a $150 premium that is to cover primary care, hospitalization and modest specialized services is a total non-starter.

One of the most prevalent proposals today would be to establish a government-funded reinsurance program to protect insurers against catastrophic losses. For that to work, it means that all major acute problems and all significant chronic diseases would have to be funded, at least in part, by the government. That is close to 80 percent of health care costs today.

If we are going to shift most of the risk of paying for health care to the government, then why should we continue to tolerate the profound administrative waste of the private insurers which direct their greatest efforts to devious means by which they can duck out of their responsibility to pay our medical bills?

In fact, the taxpayers are already paying 60 percent of the health care tab.

The insurers don’t want to insure our risk pools, and we don’t want to waste our funds on their administrative excesses. The solution seems obvious. Throw them out and establish our own publicly-funded and publicly-administered health insurance program.

In an equitably-funded public insurance system we would never again have to ask how a person with a $24,500 per year income could afford either health care or the insurance to pay for it.