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Plaintiff Cry: When Retirees Sue an Ex-Employer

Plaintiff Cry: When Retirees Sue an Ex-Employer

Sue an Ex-Employer
By Ellen E. Schultz
Staff Reporter of The Wall Street Journal
November 10, 2004; Page A12

When retirees of GenCorp Inc. were told the company was going to start charging them for health insurance, despite a labor contract they say promises coverage for life, John Van Dyke thought fighting back in court was the answer. “I was sure that once the judge saw the contract, it would be over,” the 76-year-old says. “How long could it take?”

So far, almost five years. What happened to the retirees shows the daunting challenges faced by the oldest Americans, union and salaried, if they go to court on their own to recover health benefits.

In January 2000, the former General Tire & Rubber began charging 2,063 hourly retirees health-care premiums. Mr. Van Dyke, a former millwright who once was active in the Rubber Workers union, quickly learned that it couldn’t help. In negotiating a contract in 1994, the union had agreed not to represent retirees in any future lawsuit.

On their own, the retirees faced their first challenge: finding a lawyer. Few lawyers take cases involving health benefits, because under the Employee Retirement Income Security Act, or Erisa, there are no punitive damages that contingency-fee attorneys can use to finance cases. All a plaintiff can win is restoration of the disputed benefit, and the judge may or may not let the plaintiff’s lawyer be reimbursed from that for the cost of preparing the case, thanks to a quirk in Erisa.

So Mr. Van Dyke passed the hat. He collected $12,000 from fellow retirees of a GenCorp plant in Jeanette, Pa. They chipped in $100 per couple, widows $50. While this would cover only a fraction of the cost of mounting a suit, he found lawyers who were willing to take the case. In August 2000, he met them at a diner in Pittsburgh, taking along a cardboard box full of union literature going back decades.

Told the suit needed named plaintiffs, he volunteered, along with fellow retirees Stanley Wotus and Ed Peksa. All three are World War II veterans who served in either Iwo Jima or Okinawa. (Veterans may qualify for some health care from Veteran’s hospitals, but there can be long waits for care and their spouses don’t qualify.)

In October 2000, they sued GenCorp in federal court in Akron, Ohio. The suit cited labor contracts promising lifetime coverage. But GenCorp, in court documents, responded that lifetime didn’t mean “at no cost.”

GenCorp also pointed to enrollment cards retirees filled out a decade ago. The cards asked the retirees either to pick a plan that had high deductibles and co-payments or continue in one that had no cost. They chose the no-cost option. But at the bottom of the form was fine print saying the signer acknowledged that “I am choosing the benefits selected on this form to replace any medical benefits available under any prior GenCorp retiree medical plan.” By signing the forms, GenCorp now argued, the retirees had released it from its obligation under the union contract.

In April 2001 came the first meeting with a judge. The retirees left early in the morning, first heading to a rendezvous with their lead lawyer. At the wheel was Mr. Van Dyke, who had the best eyesight. Still, at 5 a.m. in the dark on the Pennsylvania turnpike, he missed his turn, he recalls.

The retirees linked up with the lawyer, William Payne of Pittsburgh, who drove them the last 180 miles in his minivan, usually used to take his sons to hockey practice. Because of their various infirmities, they had to pull over several times. Mr. Van Dyke had part of his stomach removed following a bout of cancer in the 1990s. Mr. Wotus was taking several medications for blood pressure and heart problems. In the back seat, Mr. Van Dyke recalls, the diabetic Mr. Peksa had taken one insulin shot too many and was passing out. “I was worried about Ed. He’s got the sugar real bad,” Mr. Van Dyke says. They pulled over and gave Mr. Peksa some juice.

They finally made it to Akron in time for the 9 a.m. court session. There, the judge pressed the two parties to settle their differences. With nothing resolved, the retirees headed home.

GenCorp then said the plaintiffs should include retirees from other plant locations besides Jeanette, Pa. The judge agreed. So the retirees recruited more volunteers to serve as plaintiffs.

A year later, a larger group headed out, this time to a mediation meeting in Cleveland. Several retirees traveled from Kentucky and Ohio, booking senior-discount rooms at the Holiday Inn. Coming farthest was Kenneth Bottolfs, now 83. He made the three-flight trip from Waco, Texas, in eight hours. Mr. Bottolfs says the health-care premium for him and his wife is now $685 a month, more than erasing his GenCorp pension of $460. “A lot have dropped out because of the inability to pay” for the health coverage, he says. “My wife says they’re waiting for everyone to die.”

Fine Print

GenCorp argues it can change union retirees’ health benefits because of a line in enrollment forms they signed nearly a decade ago:
I have read the brochure which explains my retiree medical benefit options under the GenCorp plan, and I am electing to enroll in the coverages stated on this form.
I agree to pay any contributions, deductibles, and copayments required under the plan, and I authorize release of information on all claims submitted for payment.
I understand that I may change coverages only under limited circumstances. I acknowledge that I have choices available, and that I am choosing the benefits selected on this form to replace any medical benefits available under any prior GenCorp retiree medical plans.
The Cleveland meeting was to see whether the retirees and the company could resolve their dispute. It failed. The retirees began their long trips home. Eight months later, the retirees went to another mediation meeting, minus Mr. Wotus, who’d had a stroke. It failed too. The judge said the case should move to trial.
The retirees traveled to Cleveland on May 14, 2003, for depositions by GenCorp. The sessions took several hours each. The retirees whiled away their waits playing cards and trading war stories, says Mr. Van Dyke.

The following August, their lawyers filed to have the suit certified as a class action. Without this, even if the named plaintiffs won, no others would get their benefits restored.

Although GenCorp had insisted the plaintiff group be expanded to include people from around the country, and this was done, GenCorp opposed its certification as a class. It said the men didn’t qualify as representatives of the whole group of retirees. The reasons: Depositions showed some had forgotten what they were thinking when they signed enrollment forms. One didn’t remember what was in GenCorp’s slide presentation explaining the benefit options eight years earlier.
What’s more, the retirees had mixed their paper work when they pooled their brochures in a cardboard box while searching for a lawyer. That constituted “spoliation,” or destroying evidence, GenCorp said, adding it would “seek appropriate remedies at a later date.” Remedies in these situations can include charging retirees for a company’s legal fees.

Finally, GenCorp said the retirees should be denied class status because they were too dispersed, and because the named plaintiffs were too sick to adequately represent everybody.

Indeed, after GenCorp filed its brief, one plaintiff, Robert Berger, 69, died in October 2003. Plaintiff Frank Polumbo, who joined the company at 16, and as a youth took part in a 1934 strike that gave birth to the Rubber Workers union, died in November. He was 89. “He was a fighter, says his widow, Mary Elizabeth, 88, who volunteered to take his place.

In December 2003, Judge Dan Polster agreed with GenCorp and denied retirees’ request to be certified as a class. “I just couldn’t believe it,” Mr. Van Dyke says.
The retirees, fearing they’d all be dead by the time the case was resolved, and worried about a statute of limitations that the company said was running out, signed up an additional 294 plaintiffs and filed another suit in July 2004. In August, the judge dismissed that case. Now the 294 retirees, most in their 80s, must file individual suits by the end of January 2005, and each pay a $150 filing fee.

The original suit continues. In its latest quarterly filing, GenCorp said it didn’t expect a trial until after next summer. Its filings also show that over five years, GenCorp’s liabilities for retiree health care have declined 16%. The company declined to comment, citing ongoing litigation.

Mr. Van Dyke got out of the hospital last February after treatment for colon cancer. He had been caring for his wife of 58 years, June, who earlier this year had a stroke and a heart attack, but in September she died.

“A lot of people want to drop out” of the suits to restore company-paid health care, he says, “but I keep telling them to hang on.”

Write to Ellen E. Schultz at ellen.schultz@wsj.com5
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Our 'Kindness Deficit' of Care

Newsweek, November 8 
Jane Bryant Quinn
 
Our ‘Kindness Deficit’ of Care

After the third presidential debate, the plight of those without health insurance vanished from political sight. No surprise there. Lack of medical care represents a moral lapse that voters love to tut-tut about but aren’t moved to fix. Fixing it might cost money, at which point the moralists usually change the subject to the weather. Besides, the uninsured tend to be powerless people whom America’s comfortable middle can ignore.
 
A cynical judgment? Sure, but true. If we cared, public policy would have changed long ago. When the elderly scream about the cost of prescription drugs, ears prick up. But 80 percent of the 45 million uninsured are what Princeton health-care analyst Uwe Reinhardt calls “low-income, hardworking stiffs “waitresses, taxi drivers, clerks, nursing-home aides, gas-station attendants. They swing no weight among policymakers; no lobby represents them; their pockets aren’t deep enough to buy congressional attention. Working stiffs have to depend on the kindness of strangers and we’re running a kindness deficit.
What’s more, failing to cover 45 million people is, indisputably, a bargain.

The uninsured received $48 billion in free or government-paid care last year (less than they needed, but so what?). Insuring them could cost about $96 billion more. Ooooh, that would raise taxes, so we look away.But does it have to raise taxes? Imagine, for a blessed moment, that we ditched our costly, inefficient, bureaucratic, paper-pushing, interfering private health insurers in favor of a single government-run system for example, Medicare for everyone. The savings in administrative costs alone could reach $325 billion, says Dr. David Himmelstein of the Harvard Medical School. Taxpayers already cover 61 percent of American health-care spending (counting both subsidies and direct payments). If that money didn’t have to be funneled through private insurers, who take 20 percent or more off the top, we could have universal care at no increase in cost.

Any rant against our carelessness toward the uninsured requires statistics, so here they are: among all working people, 61 percent receive employer coverage, down from 65 percent in 2001 (Kaiser Family Foundation). One out of three people under 65that’s 85.2 millionwent uninsured at some point during 2002-03 (Families USA). The proportion of doctors giving charity care dropped to 71.5 percent in 2001, from 76.3 percent in 1997 (Center for Studying Health System Change). Among people 51 to 61, the uninsured are 63 percent more likely to suffer declining health, over a four-year period, than the insured (Center on an Aging Society). All of us “comfortables” stay insured only because we keep our jobs or can afford to pay private-insurance premiums, whose cost has been soaring at three times the rate of earnings over the past four years.

Nevertheless, Big Medicine holds enough power to beat down true reform. You
can still be spooked by phrases like “government-run health care,” even though that defines Medicare, which you want more of. You’re also hearing a fierce assault on Canada’s universal coverageclaims that patients get poor care, wait months for treatment and flee to the United States for surgery. In truth, only a fraction of 1 percent of Canadians seek care in the United States, says health expert Steven Lewis of Access Consulting in Saskatoon, Saskatchewan. Canada does have waiting lines of eight to 12 weeks for surgery not considered urgent, owing to ceilings on what the government will spend. Maybe more patients would come south if they could afford it. But for most, the wait seems a reasonable trade-off for coverage that’s broad, universal and secure. Anyway, the United States doesn’t have to go that route. We spend nearly twice what Canada does per person. If that same money were applied to a universal program here, no one would wait. Canada outscores the United States in such basic health measures as longevity and infant mortality (not to mention cheap drugs and flu shots). “If the purpose of a health-care system is to improve health,” Lewis says, “Canada wins hands down.”

All health systems have pluses and minuses; all ration health care in some way. We ration it, harshly, by income and price. People with money and access command topnotch care. Those without scramble for what they can get. Big businesses negotiate good group-health insurance. Small businesses are pushed against the wall. The healthy find private policies, the sick get kicked out. That’s the American Way.The next Congress may give a nod to the uninsured, says Karen Davis, head of the Commonwealth Fund, which studies health policy. Maybe tax credits for people who lose their jobs, to help them buy interim, COBRA coverage, or eliminating the two-year waiting period that keeps the disabled from Medicare.

But will we make a fundamental fix? Nah. Too many rich, corporate players have a stake in the status quo. Princeton’s Reinhardt distills our chosen policy this way: the suffering of a few million Americans, while regrettable, is a price well worth paying for fine coverage for the rest of us. What’s really regrettable is that that sounds, to most Americans, OK.

Our ‘Kindness Deficit’ of Care

Newsweek, November 8 
Jane Bryant Quinn
 
Our ‘Kindness Deficit’ of Care

After the third presidential debate, the plight of those without health insurance vanished from political sight. No surprise there. Lack of medical care represents a moral lapse that voters love to tut-tut about but aren’t moved to fix. Fixing it might cost money, at which point the moralists usually change the subject to the weather. Besides, the uninsured tend to be powerless people whom America’s comfortable middle can ignore.
 
A cynical judgment? Sure, but true. If we cared, public policy would have changed long ago. When the elderly scream about the cost of prescription drugs, ears prick up. But 80 percent of the 45 million uninsured are what Princeton health-care analyst Uwe Reinhardt calls “low-income, hardworking stiffs “waitresses, taxi drivers, clerks, nursing-home aides, gas-station attendants. They swing no weight among policymakers; no lobby represents them; their pockets aren’t deep enough to buy congressional attention. Working stiffs have to depend on the kindness of strangers and we’re running a kindness deficit.
What’s more, failing to cover 45 million people is, indisputably, a bargain.

The uninsured received $48 billion in free or government-paid care last year (less than they needed, but so what?). Insuring them could cost about $96 billion more. Ooooh, that would raise taxes, so we look away.But does it have to raise taxes? Imagine, for a blessed moment, that we ditched our costly, inefficient, bureaucratic, paper-pushing, interfering private health insurers in favor of a single government-run system for example, Medicare for everyone. The savings in administrative costs alone could reach $325 billion, says Dr. David Himmelstein of the Harvard Medical School. Taxpayers already cover 61 percent of American health-care spending (counting both subsidies and direct payments). If that money didn’t have to be funneled through private insurers, who take 20 percent or more off the top, we could have universal care at no increase in cost.

Any rant against our carelessness toward the uninsured requires statistics, so here they are: among all working people, 61 percent receive employer coverage, down from 65 percent in 2001 (Kaiser Family Foundation). One out of three people under 65that’s 85.2 millionwent uninsured at some point during 2002-03 (Families USA). The proportion of doctors giving charity care dropped to 71.5 percent in 2001, from 76.3 percent in 1997 (Center for Studying Health System Change). Among people 51 to 61, the uninsured are 63 percent more likely to suffer declining health, over a four-year period, than the insured (Center on an Aging Society). All of us “comfortables” stay insured only because we keep our jobs or can afford to pay private-insurance premiums, whose cost has been soaring at three times the rate of earnings over the past four years.

Nevertheless, Big Medicine holds enough power to beat down true reform. You
can still be spooked by phrases like “government-run health care,” even though that defines Medicare, which you want more of. You’re also hearing a fierce assault on Canada’s universal coverageclaims that patients get poor care, wait months for treatment and flee to the United States for surgery. In truth, only a fraction of 1 percent of Canadians seek care in the United States, says health expert Steven Lewis of Access Consulting in Saskatoon, Saskatchewan. Canada does have waiting lines of eight to 12 weeks for surgery not considered urgent, owing to ceilings on what the government will spend. Maybe more patients would come south if they could afford it. But for most, the wait seems a reasonable trade-off for coverage that’s broad, universal and secure. Anyway, the United States doesn’t have to go that route. We spend nearly twice what Canada does per person. If that same money were applied to a universal program here, no one would wait. Canada outscores the United States in such basic health measures as longevity and infant mortality (not to mention cheap drugs and flu shots). “If the purpose of a health-care system is to improve health,” Lewis says, “Canada wins hands down.”

All health systems have pluses and minuses; all ration health care in some way. We ration it, harshly, by income and price. People with money and access command topnotch care. Those without scramble for what they can get. Big businesses negotiate good group-health insurance. Small businesses are pushed against the wall. The healthy find private policies, the sick get kicked out. That’s the American Way.The next Congress may give a nod to the uninsured, says Karen Davis, head of the Commonwealth Fund, which studies health policy. Maybe tax credits for people who lose their jobs, to help them buy interim, COBRA coverage, or eliminating the two-year waiting period that keeps the disabled from Medicare.

But will we make a fundamental fix? Nah. Too many rich, corporate players have a stake in the status quo. Princeton’s Reinhardt distills our chosen policy this way: the suffering of a few million Americans, while regrettable, is a price well worth paying for fine coverage for the rest of us. What’s really regrettable is that that sounds, to most Americans, OK.

A crisis too loud to ignore

A crisis too loud to ignore
Nov 5, 2004
By: Robert Lowes
Medical Economics

I began writing this in a hotel bathroom in San Francisco. Only there could I escape the racket of a picket line 20 floors below and hear myself think: Maybe doctors shouldn’t view national health insurance as a dirty idea.

The pickets were bellhops, waiters, room cleaners, and the like. Their union had struck four hotels; 10 other hotels had locked out their union employees in response.

I had a window on this war from my room at the Renaissance Parc 55. Its workers weren’t striking, but I could see picketers across the street at the Hilton. Some carried signs reading “Healthcare is a Right” while others drummed buckets, blew whistles, and chanted from 7 a.m. to 10 p.m., the limits set for noise-making. A renegade drummer woke me up at 2 a.m. Earplugs courtesy of the hotel were useless.

The din was unnerving but understandable. A proposed contract would increase a worker’s health in-surance premium from $10 a month, an unbelievably low amount, to $273.42 a month in five years, an unbelievably high amount. That’s more than my premium, and I make more than they do.

I asked Violeta Sarmiento, a 58-year-old housekeeping supervisor, whether she could afford $273.42 a month in premiums.

“Oh, my God, no,” said Sarmiento. “It’s too much; we can hardly pay our mortgage now.”

But shouldn’t employees assume a bigger share of the healthcare tab?

“No, no, no,” she said. “We’re not going to give Hilton anything from our pocket. They earn billions.”

Sarmiento has a point. Like other businesses, Hilton faces skyrocketing healthcare costs, but it earned $112 million in the first half of 2004.

Nationwide, millions of laid-off workers have lost insurance coverage. Millions more who’ve kept their jobs find it costlier. You, of course, encounter this crisis every day. If you’re like the doctors I know, you respond quietly but heroically by treating that hard-pressed, uninsured patient and tearing up the bill.

But this generosity applies the proverbial Band-Aid to a systemic problem. So what’s the systemic solution? “We don’t have national health insurance,” said Tim Miller, a waiter turned picket captain. “Shame on America.”

Maybe national health insurance strikes you as socialized medicine. But our society must replace the current system with something that’s fairer and more compassionate. I was heartened by the report of a surgeon who grabbed a sign and joined the hotel strikers. If anybody has the moral authority to provide leadership on this issue, it’s the healing profession.

The presidential election is over, but the crisis remains. Whatever we do, we can’t succumb to the temptation to stick in earplugs. Otherwise, the drumming will only get louder.

The Defeat of California's Employer Mandate

Other changes in health care may be sought
By Barbara Feder Ostrov
The Mercury News – Nov. 4, 2004

These comments are in response to the relatively narrow defeat of Proposition 72, California’s play or pay employer mandate.

Any “son of Proposition 72” proposals would need to incorporate cost controls and ease the financial burden on smaller businesses, said Rick Brown, who heads the University of California-Los Angeles Center for Health Policy Research.

“Everybody knows that the one option we don’t have is the status quo,” said Anthony Wright, executive director of the advocacy group Health Access. “The health care system is unraveling. People see it every time an employer scales back and drops coverage, every time an emergency room closes.”

http://www.mercurynews.com/mld/mercurynews/living/health/10096491.htm

Comment: The majority of voters are healthy and they have insurance coverage. They are concerned about health care costs, but they are even more concerned about disruption of their current perceived health security. Our message to them will have to be crafted to show them that we can provide significantly greater financial and health security. Let’s work on it.

The Defeat of California’s Employer Mandate

Other changes in health care may be sought
By Barbara Feder Ostrov
The Mercury News – Nov. 4, 2004

These comments are in response to the relatively narrow defeat of Proposition 72, California’s play or pay employer mandate.

Any “son of Proposition 72” proposals would need to incorporate cost controls and ease the financial burden on smaller businesses, said Rick Brown, who heads the University of California-Los Angeles Center for Health Policy Research.

“Everybody knows that the one option we don’t have is the status quo,” said Anthony Wright, executive director of the advocacy group Health Access. “The health care system is unraveling. People see it every time an employer scales back and drops coverage, every time an emergency room closes.”

http://www.mercurynews.com/mld/mercurynews/living/health/10096491.htm

Comment: The majority of voters are healthy and they have insurance coverage. They are concerned about health care costs, but they are even more concerned about disruption of their current perceived health security. Our message to them will have to be crafted to show them that we can provide significantly greater financial and health security. Let’s work on it.

Vote!

MSN Money
(Accessed 11/2/04)
Bush, Kerry and the great health-care divide
By Philipp Harper

They receive about half as much medical care as the rest of us, and as a result get sicker faster and die younger.

They’re the 44 million Americans who this year will live their lives without the benefit of a health insurance safety net. How they’re regarded by their fellow citizens could be one of the key turning points of the upcoming presidential election.

The question is simple: Do they represent a vexing cost or an unprecedented investment opportunity?

The candidates have voiced their opinions and they couldn’t be in sharper contrast.

At its most basic, the debate over health care is about how large a role the federal government should have in our economic lives. As such, it crystallizes like few other issues the philosophical divergence between Republicans and Democrats.

The fact that a new revenue source would have to be found to pay for the out years of the Kerry health plan has Republicans screaming “tax and spend.” What that label ignores, however, is that federal spending to promote a healthy population may constitute an investment rather than an expense.

Some voters will view that spending as an investment leading to a fine return, others as a confiscatory tax. Which viewpoint holds sway could well determine who occupies the White House for the next four years.

http://moneycentral.msn.com/content/Insurance/Insureyourhealth/P95373.asp
Comment: If you have not done so already, go out and vote. Now!

FDA Memo Indicates Vioxx Might Have Contributed to About 27K Heart Attacks, Death

Wednesday, November 03, 2004
Coverage & Access
FDA Memo Indicates Vioxx Might Have Contributed to About 27K Heart Attacks, Deaths

Arthritis medication Vioxx, which maker Merck voluntarily withdrew from the market in September, might have contributed to an estimated 27,785 heart attacks and sudden cardiac deaths between 1999 and 2003, according to an FDA memo published online Tuesday, the Bloomberg/Baltimore Sun reports. David Graham, associate director for science in FDA’s office of drug safety and author of the memo, made the estimate based on 92.8 million U.S. prescriptions for Vioxx between 1999 and 2003. According to the memo, 27,785 more patients taking Vioxx may have had heart attacks, some causing death, than those taking Celebrex (Bloomberg/Baltimore Sun, 11/3).

Part of Earlier Study
The memo is part of a study Graham conducted with Kaiser Permanente (Bloomberg/New York Times, 11/3). For that research, Graham and colleagues examined records for 1.39 million members of Kaiser Permanente, including 26,748 who took Vioxx and 40,405 who were on Pfizer’s COX-2 inhibitor Celebrex. The study found that high doses of Vioxx, or rofecoxib, tripled risks of heart attacks and sudden cardiac death. Graham planned to present the findings at an epidemiology conference Aug. 25, but his supervisors said the results were “too preliminary” and recommended that the study be submitted first to a medical journal so it could undergo peer review or be presented at the conference with an alternative FDA opinion. When the study was presented Aug. 25, the abstract said, “[T]his and other studies cast serious doubt on the safety of rofecoxib … and its use by physicians and patients” at doses exceeding 25 milligrams. “When Graham submitted a revised, final version to FDA on Sept. 30, FDA’s announcement of the study’s release did not mention specific data on cardiovascular risks (Kaiser Daily Health Policy Report, 10/8).

Internal Documents
Prior to Merck’s withdrawal of Vioxx, about 20 million U.S. residents had taken the medication. The Wall Street Journal on Monday reported that internal e-mails, marketing documents and interviews with outside scientists who questioned the safety of Vioxx indicated that Merck was aware of safety concerns related to the medication and sought to hide them to protect sales. The internal documents are among those presented as evidence in lawsuits filed against Merck since 2001 on behalf of former Vioxx users who allegedly experienced heart attacks or strokes as a result of the medication (Kaiser Daily Health Policy Report, 11/1). Merck’s shares declined 5.2%, or $1.48, to $26.80 on Tuesday, following a 9.7% loss Monday when the internal documents were revealed (Talley, Wall Street Journal, 11/3). Merck’s shares have declined 42% this year.

Reaction
Merck spokesperson Chris Loder said, “In general, there is no reliable way to measure the actual use of Vioxx in the population, and therefore no reliable way to estimate the actual events. Because heart attacks and strokes occur in the general population, one cannot say that if someone had an event while taking Vioxx, that Vioxx caused it.” Analyst Ira Loss of Washington Analysis said, “We are in a situation where there seems to be no end to negative reaction for Merck, even if the news has been previously reported” (Bloomberg/Baltimore Sun, 11/3). The FDA memo is available online. Note: You must have Adobe Acrobat Reader to view the report.

Susan Dentzer's Innovative Proposal for Reform

It’s the Taj Mahal of Health Insurance Schemes
By Susan Dentzer (health correspondent for “The NewsHour With Jim Lehrer” on PBS)
The Washington Post – October 31, 2004

Following are excerpts from Susan Dentzer’s response to a Washington Post news story of an uninsured carpenter from Durham, N.C. who outsourced his own heart surgery to India, at a cost of $10,000, including transportation. He could not afford the $200,000 his surgery would have cost in this country.

Good grief, why didn’t someone think of this earlier! Forty-five million americans lack health insurance, and covering every one of them would be costly. Why not outsource them all to India?

Opponents will immediately say this idea is impractical. I say, don’t be health coverage girlie men! First, not all the uninsured would have to travel to India to get health care. For example, when an uninsured person first got the sniffles, he or she could pick up the phone and talk with someone at a call center in, say, Bangalore. An Indian nurse making $10 a day would listen (sympathetically, of course) and offer advice.

For those uninsured in need of hands-on medical care, here’s an idea: What if some of those failing U.S. airlines converted to running medical air shuttle services between, say, New York and New Delhi, or Boston and Bombay? Uncle Sam could hire them as private contractors, then pay them to ferry the uninsured back and forth.

The more I think about this idea, the better I like it. Just imagine all the problems it would solve: No more overcrowded emergency rooms choked with uninsured patients. No more worries about a nursing shortage; by transferring our patients to India, we’d outsource nursing care there, too. Hospitals and doctors here would be freed up to do what makes most sense for them economically: treat well-insured patients at steep prices — even to the point of giving them care that they probably don’t need! Perform the most lucrative elective surgeries on relatively healthy patients, rather than giving high-cost care to the sickest loss leaders!

We all know the uninsured are a terrible problem, an embarrassment, really, for such a rich country as ours. Every other major industrialized nation has figured out how to provide health coverage to most, if not all, of its citizens. At last, here’s a twist on globalization that could really work for everybody. So let’s get started. Who says Americans can’t take care of their own?

http://www.washingtonpost.com/ac2/wp-dyn/A11196-2004Oct30?language=printer

Comment: Susan Dentzer’s proposal certainly should embarrass us all. The $1.8 trillion that we are already spending on health care is more than enough to provide high quality, comprehensive health care for absolutely everyone. Her facetious proposal stands in stark contrast to well understood and effective policy solutions that would provide us with an affordable health care utopia. When we already have the resources, we should be ashamed that we continue to allow them to be frittered away when there is so much unmet need.

Appropriate are comments from today’s USA Today editorial on the president’s challenge to unite the nation:

“Almost every expert agrees that the (health care) system is not sustainable, and 70% of voters polled Tuesday said they were ‘very concerned’ about the availability and cost of health care.”

“The first step toward a bipartisan approach is to agree on universal coverage as a goal and be honest about its cost.”

“Only with a common starting point is there any hope of fighting off the lies spread by the interests that profit from the weaknesses of the current system.”

http://www.usatoday.com/news/opinion/editorials/2004-11-03-our-view_x.htm

(Being honest about costs includes being completely honest about the advantages and disadvantages of government versus market mechanisms of controlling costs.)

Susan Dentzer’s Innovative Proposal for Reform

It’s the Taj Mahal of Health Insurance Schemes
By Susan Dentzer (health correspondent for “The NewsHour With Jim Lehrer” on PBS)
The Washington Post – October 31, 2004

Following are excerpts from Susan Dentzer’s response to a Washington Post news story of an uninsured carpenter from Durham, N.C. who outsourced his own heart surgery to India, at a cost of $10,000, including transportation. He could not afford the $200,000 his surgery would have cost in this country.

Good grief, why didn’t someone think of this earlier! Forty-five million americans lack health insurance, and covering every one of them would be costly. Why not outsource them all to India?

Opponents will immediately say this idea is impractical. I say, don’t be health coverage girlie men! First, not all the uninsured would have to travel to India to get health care. For example, when an uninsured person first got the sniffles, he or she could pick up the phone and talk with someone at a call center in, say, Bangalore. An Indian nurse making $10 a day would listen (sympathetically, of course) and offer advice.

For those uninsured in need of hands-on medical care, here’s an idea: What if some of those failing U.S. airlines converted to running medical air shuttle services between, say, New York and New Delhi, or Boston and Bombay? Uncle Sam could hire them as private contractors, then pay them to ferry the uninsured back and forth.

The more I think about this idea, the better I like it. Just imagine all the problems it would solve: No more overcrowded emergency rooms choked with uninsured patients. No more worries about a nursing shortage; by transferring our patients to India, we’d outsource nursing care there, too. Hospitals and doctors here would be freed up to do what makes most sense for them economically: treat well-insured patients at steep prices — even to the point of giving them care that they probably don’t need! Perform the most lucrative elective surgeries on relatively healthy patients, rather than giving high-cost care to the sickest loss leaders!

We all know the uninsured are a terrible problem, an embarrassment, really, for such a rich country as ours. Every other major industrialized nation has figured out how to provide health coverage to most, if not all, of its citizens. At last, here’s a twist on globalization that could really work for everybody. So let’s get started. Who says Americans can’t take care of their own?

http://www.washingtonpost.com/ac2/wp-dyn/A11196-2004Oct30?language=printer

Comment: Susan Dentzer’s proposal certainly should embarrass us all. The $1.8 trillion that we are already spending on health care is more than enough to provide high quality, comprehensive health care for absolutely everyone. Her facetious proposal stands in stark contrast to well understood and effective policy solutions that would provide us with an affordable health care utopia. When we already have the resources, we should be ashamed that we continue to allow them to be frittered away when there is so much unmet need.

Appropriate are comments from today’s USA Today editorial on the president’s challenge to unite the nation:

“Almost every expert agrees that the (health care) system is not sustainable, and 70% of voters polled Tuesday said they were ‘very concerned’ about the availability and cost of health care.”

“The first step toward a bipartisan approach is to agree on universal coverage as a goal and be honest about its cost.”

“Only with a common starting point is there any hope of fighting off the lies spread by the interests that profit from the weaknesses of the current system.”

http://www.usatoday.com/news/opinion/editorials/2004-11-03-our-view_x.htm

(Being honest about costs includes being completely honest about the advantages and disadvantages of government versus market mechanisms of controlling costs.)

Public Opinion of Consumer-Driven Plans

What’s Important In A Health Plan?
Kaiser Family Foundation
Health Poll Report – September/October 2004

Which one of the following do you think is the MOST important reason to have health insurance?

71% – To protect against high medical bills
25% – To pay for everyday health care expenses
03% – Don’t know

Catastrophic Coverage: Opinions

Suppose you heard about a type of insurance plan that only starts paying once you (and your family) have paid ($2,000/$5,000) of medical expenses out of your pocket. After that, it would cover medical expenses like traditional insurance, requiring you to pay some co-payments each time you use services. The monthly premium for the plan would be less than half of what you would pay for a typical comprehensive health insurance policy.

Would you have a favorable or unfavorable opinion about this type of health plan?

56% – Very unfavorable
21% – Somewhat unfavorable
13% – Somewhat favorable
05% – Very favorable

Would you feel well protected, or would you feel vulnerable to high medical bills with this type of health plan?

79% – Vulnerable
16% – Well protected
05% – Don’t know

Consumer-Driven Plans: Opinions

(Asked of those with employer-sponsored health insurance) There is a new type of health plan that some employers are considering. It works like this: your employer pays for a health plan that only starts to pay after you have spent ($2,000/$4,000) in medical expenses. They also put ($1,000/$2,000) in an account you can use for medical costs. If your medical expenses are more than ($1,000/$2,000), you have to pay with your own money until you hit the ($2,000/$4,000) limit.

Would you have a favorable or unfavorable opinion about this type of health plan?

52% – Very unfavorable
21% – Somewhat unfavorable
16% – Somewhat favorable
06% – Very favorable
05% – Don’t know

Would you feel well protected, or would you feel vulnerable to high medical bills with this type of health plan?

78% – Vulnerable
18% – Well protected
05% – Don’t know

And by political party and ideology – unfavorable opinion of these consumer-driven plans:

67% of Republicans
74% of Independents
78% of Democrats

68% of Conservatives
70% of Moderates
79% of Liberals

http://www.kff.org/healthpollreport/Oct_2004/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=48477

Comment: The proponents of consumer-driven health coverage have been successful in persuading the public to parrot their rhetoric that health insurance should not be used to pay for everyday health care expenses, but that the purpose is to protect against high medical bills. So the public has bought the rhetoric, but do they really believe it?

Much more significant in this poll are the responses of the public when asked about proposals that would fund everyday expenses out-of-pocket or through personal accounts. It is very clear that the overwhelming majority correctly perceive that these proposals would leave them vulnerable to high medical bills.

Other polls have repeatedly confirmed that the number one health care concern for most Americans is affordability, whether that be for insurance or for actual health care.

It is fascinating to note that this issue is not partisan. Liberals and conservatives agree that we want affordable health care. The single payer model would accomplish this. Are we ready to sit down together to begin seriously addressing the real policy issues behind reform? Or are the conservatives going to stubbornly watch their own care become less and less affordable merely to avoid admitting that our government really can be an effective partner in health care?

The government already funds 60% of our health care (when tax incentives are included). Isn’t it time to demand accountability for our public health care investment? Isn’t accountability a goal of conservatives with which we all can agree?

National health insurance policy law by year-end

National health insurance policy law by year-end
By Hani M. Bathish
31 October 2004

DUBAI ” The National Health Insurance Policy Law could be on the books by the end of the year, as the draft of the proposed law has already been submitted, an official from the UAE Ministry of Health has confirmed but stressed that the National Health Insurance Authority, the body that would administer the national health insurance scheme, will take a little longer to set up and could be ready by mid-2005.

Khaleej Times reported earlier this year on the formation of a committee of five experts and MoH officials that will determine the shape and scope of the proposed National Health Insurance Scheme. The committee is planning to meet in the near future although no date has been set for that meeting that could be held after Eid Al Fitr.

The committee is focused on making sure that the low-paid expatriate workers are not denied access to health care, and that access to health care is not linked to the ability to pay for medical treatment.

Earlier this year Hassan Ahmad Alkeem, Undersecretary of the MoH, said that the much-awaited health insurance scheme would be implemented by the end of the year. This now seems far-fetched as the committee balks at the amount of work left to be done.

The National Health Insurance Authority (NHIA), will be an independent health authority headed by the UAE Minister of Health, Hamad Abdel Rahman Al Midfa, and set up to supervise the health care facilities of the ministry, the delivery of medical services to the general public and the management of national health care spending.

Everyone in the health care industry would agree that the existing public health care system is both inadequate and overburdened, but the fact remains that there are many who doubt the feasibility of setting up the health insurance scheme by the end of this year, among these doubters are some in the insurance industry.

Health insurance will be compulsory for expatriates working and residing in the UAE, just as health cards are today. One of the suggested methods of financing the scheme is a two per cent payroll deduction from employees, to be matched by employers and the government. Sources have said this method of funding would generate around Dh1.2 billion in annual revenues, sufficient income to support the much-needed improvements to the public health infrastructure.