SFGate.com
April 26, 2003
Despite budget woes, lawmakers trying to deal with uninsured
By Steve Lawrence, Associated Press Writer

…California legislators have introduced at least five bills designed to reduce the number of uninsured.

They range from a measure to increase the number of people covered by the state’s Healthy Families program to a bill that would set up a state-run universal health care system with an elected commissioner.

In between are bills that would require all or most employers to offer their workers health coverage.

The bill that seems to have the best chance of passing is a measure by Senate President Pro Tem John Burton, D-San Francisco, and Sen. Jackie Speier, D-Daly City, who chairs the Senate Insurance Committee.

Not only is it co-authored by Burton, who is generally considered to be the Legislature’s most influential member, it has the support of labor leaders and the California Medical Association, a powerful physicians’ group. Art Pulaski, executive secretary-treasurer of the California Labor Federation, predicts it will also win some business support.

Commonly known as a “pay or play,” it would require employers to pay at least 80 percent of the cost of a health insurance policy for their employees, either by buying the policies themselves or contributing to a state fund that would provide coverage.

Sen. Sheila Kuehl, D-Santa Monica, says the ultimate solution is the so-called “single payer” approach in her bill, which would create one state fund to provide health insurance for all Californians.

It’s the only plan that would cover all Californians and actually cut health care spending by reducing administrative costs and eliminating health care profits, Kuehl says.

The Lewin Group, a consulting firm based in Falls Church, Va., looked at nine health insurance options for the state Health and Human Services Agency in 2002, including three single-payer proposals, and concluded the single-payer approach could save the average family up to $813 a year.

But single-payer proposals have been tough to enact. California voters rejected one in 1994.

Voters tend to oppose single payer plans because they take them from their current insurance to something unknown, says John Sheils, a vice president with the Lewin Group.

But Kuehl says she’ll keep bringing it back as many times as it takes. “It’s truly the only plan that makes sense for California.”

On the Net: Read the bills, SB2, AB30, SB921, AB1527, AB1528, at www.senate.ca.gov and www.assembly.ca.gov

http://www.sfgate.com/cgi-bin/article.cgi?f=/news/archive/2003/04/26/state14 13EDT0073.DTL

Los Angeles Times
April 23, 2003
County-USC Doctors Say Delays Fatal
By Tracy Weber and Charles Ornstein

Emergency room patients regularly wait as long as four days for a bed at Los Angeles County-USC Medical Center, and some die before receiving critical medical treatment, according to sworn declarations by the hospital’s own doctors.

…the case of a 40-year-old woman with an arterial blockage in her lungs who was kept in the emergency room for more than 30 hours because an intensive care unit bed was not available. She suffered cardiac arrest and died.

…another case, doctors couldn’t treat a patient with shortness of breath quickly enough. “This patient died before we were able to help him…”

…an ER in which as many as 156 patients were crowded into 43 treatment areas, exams were conducted in the hallways, and there was “no such thing” as patient privacy.

“Imagine trying to maintain your dignity while using a bedpan in a hallway lined with stretchers.”

“We often have to squeeze three patients, both men and women together, into one booth designed to hold two. The lights are never turned off, the noise level is high, there are no facilities to wash and there is no privacy.”

…noncritical patients are waiting 16 hours or more just to be treated by a doctor in County-USC’s emergency room. If they need a bed upstairs, some are forced to wait a day or longer.

According to the county Emergency Medical Services Agency, County-USC asked ambulances to stay away nearly 75% of the time last year because it had nowhere to place patients. Paramedics who nonetheless deliver patients often must sit and wait for hours to transfer the patient from their gurney to one at the hospital.

Those who need immediate treatment for a fractured pelvic bone can wait up to two weeks for care. And patients who need surgery for such injuries as repeated shoulder dislocations could wait years.

…a 75-year-old woman admitted with a broken hip had to wait a week for surgery because no bed was available. She developed a blood clot from lying prone for so long and died despite the surgery.

…a 30-year-old pregnant woman with gallstones was forced to wait 10 days for surgery. She developed an infection of the gall bladder, which spread to her blood. She lived; her baby died.

In January, the Los Angeles County Board of Supervisors voted to authorize the closure of the first 50 beds at County-USC, along with the closure of Rancho Los Amigos National Rehabilitation Center in Downey. The remaining 50 beds are scheduled to be cut next year.

http://www.latimes.com/news/printedition/front/la-me-usc23apr23002425,1,1172 782.story?coll=la%2Dheadlines%2Dfrontpage

Comment: We’ve all heard many times the following generic quote. “The United States has the greatest health care system in the world, and we don’t want any part of rationing like they have in Canada and England.”

Well we do have the greatest resources, far more than enough to prevent inhumane rationing of urgent care. But we have the worst system of funding care, which results in health care conditions far worse than those in nations with less health care spending but with greater equity in resource allocation.

If we had a single payer system in the United States the horror story above would never have been written.

The New York Times
April 24, 2003
Proposals Attach a Price to Universal Health Care
By Milt Freudenheim

…a foundation (Commonwealth Fund) proposed spending $90 billion a year to cover almost every uninsured American.

http://www.nytimes.com/2003/04/24/national/24CARE.html

Washington Post
April 24, 2003
Gephardt Health Plan to Cover All
By Dan Balz

Rep. Richard A. Gephardt (Mo.), in a bid to set the Democratic agenda for the 2004 presidential campaign, proposed today an ambitious plan to provide access to health insurance to all Americans, at an initial cost of about $210 billion a year…

http://www.washingtonpost.com/wp-dyn/articles/A27256-2003Apr23.html

Tri-Valley Herald
April 24, 2003
High cost burdens insurance proposal
By Rebecca Vesely

A plan hatched by Blue Shield of California requiring health benefits for all residents would cost taxpayers and employers an additional $7.8 billion (for California), according to a new study.

Bruce Bodaken, chairman and CEO of Blue Shield of California, announced the findings…

http://www.trivalleyherald.com/Stories/0,1413,86~10669~1347104,00.html

Comment: These proposals have helped to revive discussion of solutions for the problem of the uninsured. These proposals build on the current system which is highly dependent on private health plans. These proposals significantly increase costs, as do all proposals that perpetuate the role of private health plans.

There is virtually universal agreement that cost containment must be a goal of reform. The only proposals that promise cost containment while providing universal coverage are those which eliminate the wasteful private plans, replacing them with a single, publicly-administered program under a global budget.

We can understand the political reasons for Richard Gephardt’s proposal, the economic reasons for Bruce Bodaken’s proposal, and the reasons for Commonwealth Fund’s attempt to achieve consensus amongst all players with their diverse interests. But isn’t it time to concentrate instead on a model that would provide truly affordable health care coverage for everyone?

MILLIMAN, USA
April 10, 2003
Health Insurance Underwriting Cycle Effect on Health Plan Premiums and
Profitability
By Richard Kipp, M.A.A.A., John P. Cookson, F.S.A., & Lisa L. Mattie, R.N.

Health care cost trends are not the only factor influencing the change in health insurance premiums. Competition, legislation, regulation and difficulty predicting future costs are all contributors to the phenomenon called the underwriting cycle-a repeating pattern of gains and losses within the insurance industry. As the cycle plays out, expected trends and the associated premium increases tend to go above or below the actual rate of change in underlying health care costs. Today, as the cycle approaches another highpoint, we see improved profitability of Plans as premium growth exceeds the growth in the costs of health care claims for Health Plan enrollees.

Today as premium growth again climbs into the double-digits, it is important to understand the role this cycle plays as we formulate a policy response to current trends.

This report first discusses the underwriting cycle in general terms, and then describes some of the actions and reactions that Health Plans’ typically exhibit at various points during a cycle. Lastly, the report discusses specific events of the 1990s that may have contributed to the pattern of insurance company profits and acted to exaggerate upward and downward swings in premium growth-swings that went well above or below the actual changes in underlying health care costs.

http://www.hospitalconnect.com/aha/press_room-info/content/MillimanReport030410.pdf

Comment: This report, prepared by a leading consulting firm for the health care industry, provides a clear description of the underwriting cycle. It is important to understand why we have intermittent periods of excessive premium increases interspersed with solvency issues that continue to threaten the stability of the health care system.

This is yet one more reason why we should abandon the use of “market forces” to control health care funding in the United States, and, instead, adopt a rational, single payer system of funding care.

National Public Radio/Kaiser Family Foundation/Kennedy School of Government
National Survey of Americans’ Views on Taxes
April 2003

14. And now I want to read a brief list of terms that are related to taxes and the federal tax system. For each, please tell me if you have heard the term and know what it means, have heard the term but don’t know what it means, or have not heard the term.

a. Progressive taxes

21% – Heard the term and know what it means
23% – Heard the term but don’t know what it means
56% – Have not heard the term

http://www.kff.org/content/2003/3340/NPRTaxSurveyToplines.pdf

Comment: One of the advantages of a single payer system is that it would be equitably funded at least partially through progressive taxes. This is one of the many messages that we must deliver to the American public before we can expect a grassroots effort to provide political traction for our proposal. If the public doesn’t even understand the concept of progressive taxation, how can we ever expect them to understand the complexities of health care reform?

We have a lot of work to do.

Brattleboro Reformer
April 19, 2003
Dr. Dynasaur cost hikes worry some
By Toby Henry

Local legislators on Friday voiced concerns about proposed increases to monthly premiums, as high as 400 percent in some cases, for families enrolled in the Dr. Dynasaur program.

Dr. Dynasaur, a Medicaid-based program introduced in 1989 to help extend preventive care to children under 18 and pregnant women, has monthly premiums ranging from $20 to a high of $50 for qualified families. According to the Office of Vermont Health Access, approximately 56,000 children and expectant mothers are enrolled in the program across the state.

Under the proposal, premiums for enrollment in the Dr. Dynasaur program would increase from $20 to $81 per month for families with incomes are between 185 and 225 percent of the federal poverty line.

Based on a study from the Vermont Public Interest Research Group, an estimated 19,000 people could leave Dr. Dynasaur and other health-care programs if the premiums go up.

“That’s not what we should be doing if our goal is to provide Vermonters with accessible, quality, affordable health care,” (Rep. Michael) Obuchowski said.

“What’s happening now is that there’s so many profit centers (in the health-care system) and so many special interests protecting those profit centers that change is difficult,” he said.

“What is happening is that as our economy contracts, people who have health insurance from their employers have to pay more in status-quo situations. It’s a situation that, cost-wise, to everyone — employers and employees alike — is out of control. The system is broken, but we’re only treating the symptoms.”

A long-term solution to the health-care concerns of all Vermonters, Obuchowski said, is the passage of a statewide single-payer health care bill.

http://www.reformer.com/Stories/0,1413,102~8862~1336550,00.html

Comment: Vermont Gov. Howard Dean, in his campaign for the Democratic nomination for president, cites the “successful” Dr. Dynasaur program of his state as part of his proposal for health care coverage for everyone. As with other programs designed for low-income individuals, Dr. Dynasaur is vulnerable to policy changes that force beneficiaries out of the program and into the ranks of the uninsured.

Rep. Obuchowski is correct. Our broken system needs to be replaced with a single payer program if we wish to assure permanent, affordable access to comprehensive care for everyone.

Brattleboro Reformer
April 19, 2003
Dr. Dynasaur cost hikes worry some
By Toby Henry

Local legislators on Friday voiced concerns about proposed increases to monthly premiums, as high as 400 percent in some cases, for families enrolled in the Dr. Dynasaur program.

Dr. Dynasaur, a Medicaid-based program introduced in 1989 to help extend preventive care to children under 18 and pregnant women, has monthly premiums ranging from $20 to a high of $50 for qualified families. According to the Office of Vermont Health Access, approximately 56,000 children and expectant mothers are enrolled in the program across the state.

Under the proposal, premiums for enrollment in the Dr. Dynasaur program would increase from $20 to $81 per month for families with incomes are between 185 and 225 percent of the federal poverty line.

Based on a study from the Vermont Public Interest Research Group, an estimated 19,000 people could leave Dr. Dynasaur and other health-care programs if the premiums go up.

“That’s not what we should be doing if our goal is to provide Vermonters with accessible, quality, affordable health care,” (Rep. Michael) Obuchowski said.

“What’s happening now is that there’s so many profit centers (in the health-care system) and so many special interests protecting those profit centers that change is difficult,” he said.

“What is happening is that as our economy contracts, people who have health insurance from their employers have to pay more in status-quo situations. It’s a situation that, cost-wise, to everyone — employers and employees alike — is out of control. The system is broken, but we’re only treating the symptoms.”

A long-term solution to the health-care concerns of all Vermonters, Obuchowski said, is the passage of a statewide single-payer health care bill.

http://www.reformer.com/Stories/0,1413,102~8862~1336550,00.html

Comment: Vermont Gov. Howard Dean, in his campaign for the Democratic nomination for president, cites the “successful” Dr. Dynasaur program of his state as part of his proposal for health care coverage for everyone. As with other programs designed for low-income individuals, Dr. Dynasaur is vulnerable to policy changes that force beneficiaries out of the program and into the ranks of the uninsured.

Rep. Obuchowski is correct. Our broken system needs to be replaced with a single payer program if we wish to assure permanent, affordable access to comprehensive care for everyone.

Health Forum Journal
Spring, 2003
Rocket Science
By Emily Friedman

The health care system makes patients feel powerless, and it makes many of those who work within it feel exactly the same way. But until we change the infrastructure and the corporate culture of health care, until the fiefdoms and the turfs and the lust for money and the competition and the power positions are broken down, until teamwork replaces individual arrogance and patients replace power mongers as the focus of the system, innocent people will continue to be terrified, humiliated, injured and killed unnecessarily–not because of any individual wrongdoing, but because the system does not and cannot serve them well. One might say the same of a dictatorship or a prison system, but we cannot allow it to be said about our work, our hopes, our goals. We can do better than that, and we must.

http://www.hospitalconnect.com/healthforumjournal/jsp/voices.jsp?voicepic=emily_pic

Health Affairs
January/February 2003
The Road To Meaningful Reform: A Conversation With Oregon’s John Kitzhaber
The first step is to call into question the basic inequities and
contradictions in our current health care system-the things we will not
openly defend.
by Jeff Goldsmith

John Kitzhaber, M.D., former governor of Oregon:

“Let’s write a health care bill which describes the policy underlying the
current system and see how many votes we get for it.”

http://www.healthaffairs.org/readeragent.php?ID=/usr/local/apache/sites/heal thaffairs.org/htdocs/Library/v22n1/s15.pdf

Comment: Given what we now know, would we create our current system of
funding health care? Tweaking this system will never right the wrongs of our
current policies. Obviously we really do need comprehensive reform based on
sound policy.

The Washington Post
April 10, 2003
Medicare HMO Benefits Down, Premiums Up
By Theresa Agovino, The Associated Press

Medicare HMO premiums are rising while the benefits they offer are diminishing for the fourth year in a row, according to a new study by a nonprofit health research firm.

“Plans don’t want to scare healthy people away with high premiums. You are seeing the plans trying to raise money in different ways like charging more for hospital stays and drug copays.” said Marsha Gold, a senior fellow at Washington-based Mathematica Policy Research who co-wrote the study using government data on the plans.

“The government shows no indication that they want to make this a profitable business for the private sector,” said Clifford Hewitt, an analyst at Legg Mason Wood Walker Inc. in Baltimore.

http://www.washingtonpost.com/wp-dyn/articles/A1944-2003Apr10.html

Comment: Perhaps “the government” has the wisdom to not only end the waste of resources on health plan middlemen, but also the wisdom to add a desperately needed prescription benefit to the traditional Medicare program.

The Washington Post
April 10, 2003
Medicare HMO Benefits Down, Premiums Up
By Theresa Agovino, The Associated Press

Medicare HMO premiums are rising while the benefits they offer are diminishing for the fourth year in a row, according to a new study by a nonprofit health research firm.

“Plans don’t want to scare healthy people away with high premiums. You are seeing the plans trying to raise money in different ways like charging more for hospital stays and drug copays.” said Marsha Gold, a senior fellow at Washington-based Mathematica Policy Research who co-wrote the study using government data on the plans.

“The government shows no indication that they want to make this a profitable business for the private sector,” said Clifford Hewitt, an analyst at Legg Mason Wood Walker Inc. in Baltimore.

http://www.washingtonpost.com/wp-dyn/articles/A1944-2003Apr10.html

Comment: Perhaps “the government” has the wisdom to not only end the waste of resources on health plan middlemen, but also the wisdom to add a desperately needed prescription benefit to the traditional Medicare program.