Member Resource – Page 761

What to Say to Those Who Think Single Payer Advocates Are Wacko

By Paul Hochfeld
CommonDreams.org
Monday, February 8, 2010

What do we say to our more conservative friends, who genuinely think that the Single Payer solution to our health care crisis would be a disaster? Try what follows. In the end, you may simply agree to disagree. That’s O.K., but what follows may give them pause to think.

Already, 60% of all our health care dollars come directly or indirectly (because employers insurance premiums are tax deductible) from the taxpayer. The care of our oldest neighbors are financed by Medicare, i.e. the taxpayers. The care of our disabled neighbors is financed by Medicaid. Ditto the care of our poorest neighbors who, because health follows wealth, are also at greater risk of high expense. Fourteen hundred insurance companies, at significant expense, stratify the rest of the population by “risk”. Their top-secret formula results in them covering the employed people, small groups, and individuals who can prove that they are at low risk. What about the others? When those who can’t afford the premiums get sick, go bankrupt, and can’t pay their bills, “we” all pay for it in higher charges. Furthermore, employer-paid premiums are tax deductible which means insurance company profits are subsidized by the taxpayer.

As near as I can tell, this is a big taxpayer rip-off. Additionally, our non-system is fraught with numerous perverse incentives that result in more care, but not necessarily better care. Physicians must share a significant part of the blame here, but that’s a different, though important, discussion. Addressing these perversities is problematic because we don’t have a Health Care System we have For-Profit Sick Care Non-System that, to extent that it has any design at all, is designed to serve the for-profit insurance and the pharmaceutical industries. Perverse incentives work for those who profit from them. They don’t work for patients or those who pay the bills, i.e., taxpayers.

Single payer means one risk pool. You’ve heard the slogan. Everyone in. Nobody out. We gather all the money that employers and individuals are currently paying for health care. It’s not more money. It’s the same money, already being spent on health care, but by pooling it, we can save 20% right off the top. Providers won’t have negotiate fee schedules with all the different payers. Providers will only have to send bills, electronically, to one place. Furthermore, substantial savings accrue as the system matures. When an ER Doctor in Oregon sees a patient passing through town, he will access her electronic medical record in Iowa, resulting in, not just less expensive care, but better care. None of this is going to be accomplished until we have Public Health Authorities administering a health care system with the goal of health, financed publicly and delivered privately.

This isn’t pie in the sky. Check out what the other developed countries are doing, but please don’t respond with anecdotes. We have 45,000 new anecdotes every year that illuminate how real or perceived financial barriers to timely, appropriate care cause unnecessary death.

The real question is whose “system” produces the least number of unnecessary deaths and the least suffering for the dollars being spent? Yes, other countries are struggling because of limited resources, but they are dealing with the problems maturely, they are making difficult decisions, and, by recognizing that health is a human right, they are getting a healthier population for less cost.

Is access to appropriate health care a human right? If not, we can agree to disagree. If so, it is a legitimate function of our government to make sure that nobody falls through the cracks. Also, doesn’t the government have a fiduciary responsibility to make sure the taxpayer is getting value for its health care dollars? Insurance company CEO’s have a fiduciary responsibility to maximize profits even if it means investing large sums of money in manipulating public policy… and that’s exactly what they’ve been doing. It’s unfathomable to me that some people distrust “The United States” more than United Health Care. That may be where we end up agreeing to disagree.

In any case, the taxpayer is being ripped off, big time.

Dr. Paul Hochfeld is an ER Doctor, producer of Health Money and Fear, and one of the Mad As Hell Doctors who traveled to DC last September. MadAsHellDoctors.com

http://www.commondreams.org/view/2010/02/08-6

Himmelstein, Woolhandler to CUNY

By Russell Mokhiber
Single Payer Action
February 8, 2010

Single payer activists David Himmelstein and Steffie Woolhandler are moving to New York City.

In the fall of 2010, they will become full professors at the City University of New York (CUNY) School of Public Health at Hunter College.

The two doctors – leaders in the movement for a single payer system in the United States – have lived and practiced in the Boston area since 1982.

Both currently teach at the Harvard Medical School.

They are co-founders of Physicians for a National Health Program.

The two single payer docs were in New York City this weekend looking for a place to live.

Both Himmelstein and Woolhandler have family in New York.

Himmelstein grew up in New York City and went to school there.

Himmelstein said that there were pushes and pulls in their decision to leave Boston and Harvard for New York and CUNY.

The pull included a “very attractive offer” from the City University where “we can do what we want and not have to worry about raising funds.”

CUNY is home to a number of public health activists – including the acting dean of the school – Kenneth Olden – and Professor Nick Freudenberg.

http://www.singlepayeraction.org/blog/?p=2098

Why does Anthem Blue Cross need a 39% premium increase?

Anthem Blue Cross dramatically raising rates for Californians with individual health policies

By Duke Helfand
Los Angeles Times
February 4, 2010
California’s largest for-profit health insurer is moving to dramatically raise rates for customers with individual policies, setting off a furor among policyholders and prompting state insurance regulators to investigate.
Anthem Blue Cross is telling many of its approximately 800,000 customers who buy individual coverage — people not covered by group rates — that its prices will go up March 1 and may be adjusted “more frequently” than its typical yearly increases.
The insurer declined to say how high it is increasing rates. But brokers who sell these policies say they are fielding numerous calls from customers incensed over premium increases of 30% to 39%, saying they come on the heels of similar jumps last year.
Insurers are free to cherry-pick the healthiest customers in the lightly regulated individual market. They can raise rates at any time as long as they notify the state Department of Insurance and prove that they are spending at least 70% of premiums on medical care.
Many policyholders say the rate hikes are the largest they can remember, and they fear that subsequent premium growth will narrow their options — leaving them to buy policies with higher deductibles and less coverage or putting health insurance out of reach altogether.
The insurer said it had a team of workers to help customers balance costs and insurance.
“Anthem offers a variety of health benefit plans,” the company said, “and we are dedicated to working with our members to find health coverage plans that are the most appropriate and affordable for their needs.”
http://articles.latimes.com/2010/feb/04/business/la-fi-insure-anthem5-2010feb05

And…

Letter from Kathleen Sebelius, Secretary of Health and Human Services, to Leslie Margolin, President, Anthem Blue Cross

U.S. Department of Health & Human Services
February 8, 2010
Excerpt:
One of the biggest pressures facing families, businesses and governments at every level are skyrocketing health insurance costs. With so many families already affected by rising costs, I was very disturbed to learn through media accounts that Anthem Blue Cross plans to raise premiums for its California customers by as much as 39 percent. These extraordinary increases are up to 15 times faster than inflation and threaten to make health care unaffordable for hundreds of thousands of Californians, many of whom are already struggling to make ends meet in a difficult economy.
Your company’s strong financial position makes these rate increases even more difficult to understand. As you know, your parent company, WellPoint Incorporated, has seen its profits soar, earning $2.7 billion in the last quarter of 2009 alone.
http://www.hhs.gov/news/press/2010pres/02/20100208c.html

And…

‘A Wasted Opportunity’

By Joseph Rago
Wall Street Journal
February 7, 2010
Mrs. (Angela) Braly is the CEO and president of WellPoint, the largest U.S. commercial health insurer by membership. Her company’s affiliated health plans in 14 states cover 34 million people—or roughly one out of nine Americans. It contracts with 82% of the nation’s primary-care physicians, 84% of specialists, and 94% of hospitals. That scale lands her on the most-wanted list in President Obama’s Washington.
The tragedy, as she sees it, is what “a wasted opportunity” it all turned out to be. “Health-care reform” soon became “health-insurance reform” exclusively. “It was a pivot that was—unfortunate,” she says, “because it is not going to solve the longer-term problem.”
The solution is to “reintroduce the consumer to the health-care equation,” and on that front, she believes, insurers “are actually the part of the health-care delivery system that is there to create the value.” Mrs. Braly thinks patients will make more cost-conscious decisions if they have the incentives and the tools—namely, the information about cost and quality that is the basis of any ordinary market.
Mrs. Braly concedes that some people with pre-existing conditions can find it difficult to find affordable coverage, especially if they lose their job, get divorced, move, etc. “It’s when people have no option that we’re really in trouble and need to find a solution,” she says. But a better alternative to central insurance planning is public-private partnerships to create insurance pools for those with high risks. “That was a great idea that got pushed aside, and I think we need to revisit that concept.”
http://online.wsj.com/article/SB10001424052748704259304575043861057904360.html?mod=rss_opinion_main

WellPoint’s California subsidiary, Anthem Blue Cross, has provoked appropriate outrage in response to its announcement of premium increases as high as 39 percent. Why would they risk creating this potential public relations nightmare when Congress is considering major increases in regulatory oversight of their industry?
Keep in mind that Anthem Blue Cross has been very successful in keeping its individual insurance products competitive by selling only to the healthy by subjecting applicants to medical underwriting. With the unabated rise in health care costs, the upward pressure on premiums has been moderated by introducing numerous innovations, especially increased cost sharing.
Currently the most important tool they have to limit their exposure to health care costs is to switch their clients to plans with high deductibles (often $5000 or more) and high coinsurance (typically 40% of all allowed costs over the deductible). You can confirm these numbers at eHealthInsurance.com.
By jacking premiums up to intolerable levels for low deductible and low coinsurance plans, they force their clients to choose these high cost sharing plans. Once enrollment drops in the low cost sharing plans, high cost individuals remain, driving premiums up even further resulting in the death spiral. At that time they can withdraw the low deductible plans from the market and require that their clients choose either the high cost sharing plans or drop their coverage altogether.
Another factor that has driven premiums up now is the high unemployment rate that has caused many individuals to drop their coverage, especially those who are relatively healthy, leaving in the plans those who try to hang on because of their greater health care needs. Of course, that adds to the death spiral.
Angela Braly, president, chairman, and CEO of WellPoint, supports greater patient cost sharing to “reintroduce the consumer to the health-care equation.” Patients will buy less health care, no matter how beneficial, when they are using their own money. That also happens to work out well for WellPoint since they will spend less on health care.
Angela Brady also wants those who need health care to be covered by public high-risk pools, while the healthy are covered by her private plans. That too allows WellPoint to spend less on health care, while we taxpayers foot the larger bills.
It would seem that the outrageous premium increases by Anthem Blue Cross would cause the administration to rethink a strategy of reform based on private insurance plans. But no. Instead HHS Secretary Kathleen Sebelius responds with a tisk, tisk, as Congress and the administration continue to move forward with locking us into this perverse system.
We need to respond with more than a tisk, tisk. We need to show up by the millions on February 25 (President Obama’s televised bipartisan health session) and demand the enactment of an improved Medicare for all of us.

Canadian medical travel executive on Premier Williams' care in the U.S.

Newfoundland premier Williams out of ICU, recovering well from heart surgery

The Vancouver Sun
February 8, 2010

Premier Danny Williams, who had heart surgery at a U.S. hospital last week, is recovering very well from the operation, a spokeswoman said Monday.

Elizabeth Matthews said the Newfoundland and Labrador premier was released from intensive care on Friday and is expected to be discharged from hospital sometime this week.

Williams’ decision to have the surgery performed at an undisclosed U.S. hospital, because the procedure wasn’t available in his home province, touched off a mini-firestorm, with some critics in Canada and the United States pointing to it as proof of problems in Canada’s health-care system.

Last week, deputy premier Kathy Dunderdale said the criticism of Williams was unwarranted and an invasion of his privacy. She said the premier would address the issue after his return home.

http://www.vancouversun.com/Newfoundland+premier+Williams+recovering+well+from+heart+surgery/2537244/story.html

And…

Danny Williams and the best health care in the world

By Mark Watson
The North Star National
February 7, 2010

Danny Williams, premier of Newfoundland and Labrador, Canada, underwent heart surgery in an undisclosed United States hospital on Thursday.

According to Deputy Premier Kathy Dunderdale, Williams received treatment from a “renowned expert in the procedure” that the premier needed.

Does Williams’s decision to travel to America for his heart surgery suggest that the procedure he needed was unavailable in Canada, or does it mean that the wait time required for getting the treatment was too long for him to survive before eligible for the procedure?

President Obama has extolled the virtues of the Canadian single-payer medical plan repeatedly in the past.

Perhaps this would be a good time for Obama and other Democratic leaders pushing hard to implement their so-called health care reform to rethink their plans.

If a Canadian-style single-payer system isn’t good enough for a Canadian premier, how long will it be until a universal medical coverage plan in America will not have sufficient resources for a member of Congress?

The fact that the Premier had to seek treatment outside his own country is an indictment of the Canadian health care system, nothing more, nothing less.

Response to Mark Watson by T. Rand Collins PhD MD
February 8, 2010

There is a great deal of sniping back and forth across the border from those who would use both systems’ problems for their own ends. Sadly, both systems are broken, but in different ways. America has excellent health care and world-class technology, but a significant part of the population cannot afford it. And another part of the population can just barely afford it, surrendering the equivalent of their mortgage each month just to be protected against a medical catastrophe. I talked in November to the owner of a clothing store in the Miami Trade Center, who told me that she was paying ~$2,000 per month for health care – and Mark Watson is knocking Obama’s efforts to make sure his people can go to the doctor?

Canadians are privileged to get complete care for a nominal cost. It may be slow, and it may have problems, but health care is a right, not a privilege.

I am, ironically, as Senior Vice President of International Health Care Providers, an Ontario-based medical travel firm, one of those who help Canadians find health care options in the US. But that doesn’t mean that I don’t believe in the Canadian system. Canada needs a private option, which is what the world’s most successful medical systems have – a combination of private AND public options for health care.

American arch-conservatives cry “Socialism” whenever government takes part in providing services or setting regulatory standards. Besides the fact that most Americans cannot define socialism (and more than a few can’t spell it), there are some things that are too important to be left to private interests whose primary interests lie in keep the shareholders happy.

Even a good concept like health care as a right for all can have times when those who manage it are short-sighted and unresponsive. Democracy was a good idea, but under Bush, who will go down in the books as the least competent president in the history of this country, freedom of speech and freedom from government spying were severely threatened.

I have dual citizenship in the US and Canada and have practiced medicine in both countries, and, were I pushed to choose, I would definitely opt for the Canadian system.

http://www.northstarnational.com/2010/02/07/4240/

International Health Care Providers
http://www.ihcproviders.com/ourteam.php

Comment:

By Don McCanne, MD

The North Star National article by Mark Watson is but one of those insensitive and distorted reports and certainly would not be worth including as a Quote of the Day, except that it provoked the response of an executive of a Canadian medical travel firm who also happens to be a physician who has practiced in both the United States and Canada.

We do not agree with Dr. T. Rand Collins that Canada needs a “private option.” That would create a two-tiered system with even longer queues in the public sector. They simply need to continue moving forward with their ongoing efforts in queue management.

Considering that Dr. Collins’ firm is in the business of bypassing Canadian queues by arranging for care in the United States, his fundamental assessment of the systems of both nations is certainly noteworthy. As he says, “… were I pushed to choose, I would definitely opt for the Canadian system.”

Canadian medical travel executive on Premier Williams’ care in the U.S.