PNHP

17 Held in Protest Outside Health Insurer’s Offices

17 Held in Protest Outside Health Insurer’s Offices

By Colin Moynihan
New York Times
City Room Blog
September 29, 2009

Right-wing and antigovernment activists — a few of them wielding not only signs but even loaded firearms — have organized some of the angry protests surrounding the health care debate. But in Midtown Manhattan on Tuesday morning, a different sort of health care protest took place, led by left-leaning groups who accused insurers of greed and called for nationwide, single-payer health insurance.

The police said that 17 people were arrested after refusing to leave the lobby of an office building on Park Avenue where the insurance company Aetna has offices. They were charged with criminal trespass. In addition, the police said, three of those arrested were charged with obstructing governmental administration.

Organizers said it was the first step of a national campaign meant to publicize their views and challenge claims made by right-wing radio hosts and Republican officials.

“The myths about government death panels are pure hysteria,” an organizer, Mark Milano, said on Park Avenue. “The real death panels are people who are paid by insurance companies to deny health care to patients.”

About 50 people arrived at the building, at Park Avenue and 40th Street, at 10 a.m., participants said, and sent a representative to the Aetna offices upstairs to demand that the company agree to immediately approve “lifesaving” health care requests made by doctors. When that person was turned away, organizers said, 16 protesters entered the lobby of the building and sat on the floor.

Soon the police arrived and a senior officer used a bullhorn to inform those in the lobby that they were breaking the law and subject to arrest. By 10:45, officers could be seen removing the last of the demonstrators and ushering them into the back of police vans.

A spokeswoman for Aetna, Cynthia Michener, said that no protester visited the company’s office on Tuesday.

“Aetna has been actively engaged in health reform,” she wrote in an e-mail message. “When you put yourself out there like we have on this issue, you make yourself a target. But there is more agreement than disagreement on the need to get reform done. It is important we work together to make health care reform a reality this year.”

Ms. Michener added:

Broadly, Aetna ‘s goals are to get everyone covered, improve the quality of health outcomes and provide better value for each dollar spent on care. We’re committed to guaranteed coverage without regard to pre-existing conditions along with an individual requirement to get everyone in the system and subsidies for those who can’t afford it.

Outside, a crowd chanted “patients not profits” and said that large insurers routinely made decisions on what sorts of treatment to cover based more on cost than medical necessity.

“This is very much a dignified, nonviolent response to what some people call the howler movement that erupted in August,” said Katie Robbins, part of an advocacy group called Healthcare Now.

There has been a backlash from some quarters against Mr. Obama’s support for a public insurance plan that would compete with private insurers.

Ms. Robbins advocates on behalf of a bill before the House of Representatives that would, essentially, expand Medicare to cover all citizens. She said organizers from several groups across the country, with networks in 40 states, had been working together for about six weeks on a campaign they called Mobilization for Healthcare for All.

The groups have organized using a Web site and Twitter. So far, organizers said, 300 people have signed up to take part in additional protests using civil disobedience and aimed at insurance companies that are being planned for October, while legislators are expected to be working on health care issues.

“We’re going to be in Chicago next week and L.A. the week after that,” Ms. Robbins said. “We’re timing this around the legislative efforts of Congress.”

Video:

http://www.youtube.com/watch?v=gqP8bEyFRAo

http://cityroom.blogs.nytimes.com/2009/09/29/17-held-in-protest-outside-health-insurers-offices/

A Sit-in at Aetna:”Aetna Is the Real Death Panel”

by Private Health Insurance Must Go!
September 30, 2009

19 citizens and health care providers arrested, launching national mobilization for health care for all

29 September 2009, New York, NY — Citizens and health care providers today staged a sit-in at the offices of Aetna, one of the nation’s largest health insurance companies, in New York City (99 Park Ave @40th. The action is part of a national mobilization to end health insurance abuses such as the denial of coverage for lifesaving treatments, and win support for the only real public option — Medicare for all, a single payer plan. The action was part of a Mobilization for Health Care for All campaign that includes actions in Chicago, Los Angeles, and other cities across the country.

The 19 participants, wearing T-shirts with slogans that read “Medicare for All” and chanting “patients, not profits!” linked arms and sat down in the lobby of the Aetna building, prompting Aetna employees to step around them on their way into their offices, where insurance claim reviewers are busy looking for ways to deny people the lifesaving treatment that they need. A crowd of supporters picketing outside the building held signs that said “Aetna is the real death panel,” and “Single payer now.”

Participants in the action demanded that the insurance company immediately approve all doctor-recommended lifesaving treatments in their files, stating that they would not leave until Aetna approved care. Aetna, however, refused to meet with their representative.

“Insurance companies are denying care to people who need it right and left, but that’s not how it should work. Health care is a right, not a privilege,” said Constancia ‘Dinky’ Romily, 68, just before getting arrested. Romily is a retired nurse and a resident of East Village, New York. “I’m putting myself on the line and getting arrested to end insurance abuse and win health care for all,” she says.

The sit-in is part of the Patients Not Profit campaign of the Mobilization for Health Care for All. The mobilization was launched by the organizations Prosperity Agenda, Health Care NOW!, and the Center for the Working Poor. Today’s action has been organized by the Private Health Insurance Must Go! coalition, a local New York organization.

“People are dying because these corporations put profits before patients, and the health care bill currently on the floor of Congress fails to address the real cause of the health care crisis — the insurance companies,” says Katie Robbins, an organizer with Healthcare-Now! “The only solution to our health care crisis is the real public option, Medicare for All, a single payer plan.”

Laurie Wen, 38, a Manhattan resident, is one of the everyday Americans who are fed up with the state of health care in our country, and was arrested today to stand up for the hundreds of Americans who are denied lifesaving care every day, and to call for the only solution for health care for all, Medicare for all. A friend of hers, she says, was recently denied by Aetna for coverage for a bone marrow transfusion to treat cancer for three months, setting his care back for three months.

“We will continue to stage these sit-ins as Congress debates legislation that expands the insurance company stranglehold over our health, our lives, and our government,” says Wen. “We need a better system to end insurance abuse and win health care for all.”

The Private Health Insurance Must Go! Coalition (PHIMGC) is a growing and diverse New York City-based non-partisan organization focused on education, legislative advocacy and direct action in the fight for single-payer healthcare reform and HR 676.

Imagine getting sick, getting bills you can’t pay, then being sent to jail

Lawsuits, lost wages, even jail can result

By Janell Ross
The Tennessean
September 28, 2009

Kenneth Hoagland went to jail for what started as a cold.

Hoagland had refinanced his Nashville home to pay off the $25,000 tab for his weeklong diabetes-related stay at Southern Hills Medical Center.

The new mortgage left Hoagland out of medical debt but afraid to get sick again.

Unfortunately, he did. In 2004, Hoagland was in a health insurance waiting period on a new job when a cold turned into two days at Vanderbilt University Medical Center. This time, the bill was just over $1,200.

When a collection attorney working for Vanderbilt filed suit in 2005, Hoagland was afraid to take time off from work to show up in court. After a series of hearings, attempts to collect the debt and what Hoagland says were genuine efforts to pay it, an attorney working for Vanderbilt asked a judge to issue what’s known as a body attachment.

One Friday in late 2008, a sheriff’s deputy went to Hoagland’s home. Because he was at work, Hoagland was allowed to turn himself in the following Monday.

“They fingerprinted me, took my picture and asked some questions about my medical history,” he said. “When the guy who tested (my blood sugar) asked me why I was there and I told him … he said, ‘I didn’t know we did that in this country.’ I told him, ‘Until now, I didn’t either.’ ”

Hoagland, 36, is one of the hundreds of thousands of Americans — insured and uninsured — facing collection suits, wage garnishments and, more rarely, trips to jail because of medical debt.

On the other side are doctors and hospitals that say they try to work with debtors and provide millions in free care, but unpaid medical bills affect their ability to care for others.

Medical debt isn’t closely tracked by courts, but it’s one of the many types of debt collection suits that keep Davidson County’s General Sessions Courts so busy that the people at the center of those cases sometimes fill the courtroom’s audience seating and even the jury box.

But it’s the docket, the list of cases that will be heard in Courtroom 5D on any given day and the people with cases on it, that really tells the story. Some entries reveal the types of services rendered.

There are cases filed by Associates in Gastroenterology, the Anesthesia Medical Group and Nashville Bone and Joint PLLC. And then, there are the names of nearly all the area’s hospitals.

The suits represent attempts to collect on bills that in cases examined this summer ranged from $81 to $22,000. They are, in most cases, bills patients never expected to accumulate.

Judge Dan Eisenstein, one of the judges who hears these cases in Courtroom 5D, said debtors summoned to court often dispute just how much is owed to a landlord or whether a credit card debt is really theirs.

But debtors rarely dispute medical bills.

“There’s not a lot of dispute because people just have no choice,” he said. “They needed the care, and the law says they have to cover their bills.

“But it’s certainly tough to come into this courtroom and see people who have been sick or hurt and cannot pay their bills.”

Medical bankruptcy rises

A study published in the American Journal of Medicine this year found that medical debt is deeply damaging the finances of American families.

Based on a survey of 2007 filings, researchers estimate 62.1 percent of all bankruptcies that year were caused by medical debt and that 92 percent of these cases involved medical bills totaling more than $5,000, or 10 percent of the family’s total pretax income.

Other cases met the researchers’ criteria for “medical bankruptcy” because they had lost significant income from illness or mortgaged a home to pay medical debt.

Most medical debtors contacted by researchers were well-educated, owned homes and had middle-class occupations. Seventy-five percent of those surveyed had health insurance.

And, researchers found, the issue of medical debt has grown over time. Between 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6 percent.

Hoagland, who works in information technology, never filed bankruptcy or disputed his bill. Instead, he made payment arrangements with Vanderbilt and tried to keep them.

Sometimes he and his fiancée, Sonya Davis, had to choose between paying their mortgage or $200 a month on medical bills, Davis said. When that happened, they paid the mortgage. They figured the family had to have a place to live, and the house had belonged to Hoagland’s parents.

Then Vanderbilt filed suit. When Hoagland missed a hearing because of a work emergency, the court ruled in his absence that Vanderbilt was due the full amount. He missed two more court dates aimed at determining his assets.

A judge issued a body attachment — a document issued in civil cases that demands defendants explain why they didn’t appear in court. Sheriff’s deputies find the defendants and, in many cases, take them to jail, where they are allowed to post bond quickly.

It’s a rare action — out of 32,126 debt cases in General Sessions Court in 2008, for example, judges issued 98 body attachments.

Hoagland made bond and the $250 that he paid was applied to his debt. His wages were garnisheed for several months, and he thought he was paid up. Then a bill arrived several weeks ago for $70 — one he said he’ll pay without question.

People delay care

Davis said the experience changed their lives.

“The choice now is, do I stay sick? Because if I go run up this bill and can’t pay for it and then get arrested again, what then? What are you supposed to do?” she said.

Two months ago, they faced that question. Hoagland went to bed with a cold and woke up so listless that Davis knew immediately something was wrong.

His blood sugar was at 39. Hoagland’s blood sugar is supposed to stay between 80 and 120. He could barely speak.

“I called the ambulance,” Davis said. “And I hate to admit this, but as soon as they got here, I thought, ‘Oh God, I hope they aren’t going to have to take him.’ He was sick, but I know he was probably thinking, ‘We can’t afford another set of medical bills.’ ”

The ambulance crew wanted to take Hoagland to the hospital but agreed to let Davis make him some breakfast and see if his blood sugar levels would normalize. They wouldn’t leave until Hoagland drank some orange juice with a bit of sugar stirred in and his blood sugar surged.

As extreme as Hoagland’s attempt to avoid another hospital bill may sound, it’s not uncommon, said Shana Alex Lavarreda, the director of health insurance studies at the University of California, Los Angeles Center for Health Policy Research.

As a result of a study released by the center this year, Lavarreda began to hear troubling stories from people across the country who had delayed medical care because of existing medical debt.

“Delays in care could be something as serious as reattaching a portion of a finger or not or getting the respirator that you need,” she said.

The situation highlights the fact that many insurance policies carry a high deductible. This can turn out to be burdensome for families without significant savings if someone becomes ill, Lavarreda said.

Drama outside courtroom

What happens inside Courtroom 5D at General Sessions Court can pale in comparison to the high drama in the hallway outside.

There, hospital debt collectors pull defendants to the side for hushed conversations about what they can realistically pay. If they can figure something out, defendants don’t have to go back inside. The payment arrangement is entered into court records, and the person who owes the debt must pay it.

On Sept. 11, all the good hallway spots — with seating — were taken. So Centennial Medical Center’s attorney beckoned Stacy Grondin up to the long tables where prosecutors and defendants usually sit facing the judge during trials.

The conversation was about the $997.74 bill Grondin incurred in 2006 at Centennial when her heart rate spiked.

“I really thought I was having a heart attack,” she said.

Grondin, a grocery store manager, is insured. But she went to the hospital in an ambulance, and that required pre-approval from the insurance company.

So did her choice to seek care in an emergency room. She didn’t have approval for that either. So when it turned out the problem was anxiety or a condition doctors couldn’t precisely determine, her claim was denied.

Tom Norris, Centennial’s attorney, leaned in close.

“What kind of payment can you make?” he asked.

“I think maybe $50,” Grondin said.

Norris accepted but declined to comment about Grondin’s case or the collection process when approached by a reporter.

On that day, the bill was actually $1,246.96 — the original amount plus $161.75 in court costs and $87.47 in interest fees. The court costs are tacked on after collection efforts fail and a suit is filed. Interest accrues on medical debt at up to 10 percent after a court issues an order to pay.

But for Grondin, 35 and a single mother of three, that’s not even the sum total of her medical debt.

While Grondin discussed her bill with Norris, her 9-year-old daughter, Emily, sat in the courtroom’s gallery waiting for her mom to finish and take her to the doctor. Grondin feared Emily might have swine flu.

The little girl with the robin’s-egg blue eyes and a pair of silvery scars on her forehead heard every word of the payment discussion.

Emily barely survived a 2003 car accident with her father at the wheel. He’d been drinking. She wasn’t strapped in. A LifeFlight helicopter took her to Vanderbilt’s children’s hospital, where doctors saved her life.

Now Emily’s father is in prison because of that accident, and her mother is trying to pay $2,115.25 in medical debt charged to a credit card. That’s the 20 percent of Emily’s bill that insurance didn’t cover, plus court costs and interest.

“They sent papers to my job a couple of months ago saying they are going to garnish my wages, I think for her accident,” Grondin said. “But that hasn’t started yet.”

Grondin said she’s not sure how to feel. There’s the reality that services were rendered. But then there’s the fact that she is insured and still left with medical bills, collectors’ phone calls and soon, maybe, a wage garnishment.

“I know it’s our responsibility. It is ultimately my responsibility to pay,” she said. “But … when I first saw all the bills I was kind of mad because I am paying for this insurance which I barely use. Then, when it’s needed, it’s hardly there.”

Grondin’s medical debt story doesn’t end there. Her boyfriend, who has two children of his own, recently declared bankruptcy because he couldn’t have afforded child support and other bills if his wages were garnisheed to collect more than $7,000 in medical bills.

‘It’s good to have a plan’

Michael Wade Taylor, 57, was in Courtroom 5D just after 9 a.m. Aug. 28 when Judge Eisenstein called his name and case. Wedged between two men with debt cases of their own, Taylor stood and answered clearly, “Here.”

Southern Hills Medical Center’s attorney waved him into the hallway to work something out.

Today, Taylor is an unemployed construction worker. He had a job but no insurance in 2006, when doctors initially thought he’d had a stroke.

He spent several days in intensive care at Southern Hills, having a stent threaded from his groin to his heart to check for blockages. Later, he took a stress test on a treadmill.

The eventual diagnosis: “They told me I had the heart of a teenager and didn’t know what was wrong with me,” Taylor said. “They sent me home, and since that time I kept going down and going down.

“Then I find out that for those four days they charged me $33,000. Thirty-three thousand dollars for nothing.”

Hospital staff checked to see if he could qualify for TennCare — state-subsidized medical coverage — but his income was too high. Then they talked with him about financial aid and setting up a payment plan. Taylor said he didn’t qualify because he didn’t have a checking account.

The bills started coming, then the phone calls, then the loss of his job in 2008.

Turns out either he didn’t have the heart of a teenager or it aged very quickly, Taylor said. Two months ago, he had open-heart surgery for an arterial blockage. This time, because he was unemployed, TennCare paid the tab.

He and Southern Hills’ attorney reached an agreement that would let Taylor pay $20 a month until he covers $3,000 of the bill from three years ago.

“It’s good to have some kind of plan,” he said. “Really having that hanging over me was just something that took a situation from bad to worse.”

Hospitals provide free care

Deals like Taylor’s — taking a $33,000 bill down to $3,000 — aren’t uncommon, area hospital systems say. They give away millions in medical care each year.

Meanwhile, they say, unpaid medical debt keeps them from covering important capital costs — such as replacing buildings and equipment — or improving treatment and services.

Each has a policy of absorbing or forgiving some medical debt, but that benefits the poorest and most severely ill patients. Employees help some patients who qualify, such as Taylor, enroll in TennCare.

In fiscal year 2009, for example, Vanderbilt had $274.3 million in unpaid medical bills and absorbed about $197.9 million of that. It writes off debt for patients whose bills exceed their annual income or who earn less than 250 percent of the federal poverty rate — about $55,000 for a family of four.

Vanderbilt provides almost half of all the uncompensated care delivered in Davidson County, spokesman John Howser said.

TriStar Health System, which operates five health-care facilities in the Nashville area, offers similar help for low-income patients.

“The No. 1 reason for charity care denials is that they do not submit the application,” spokeswoman Teri Smith said.

The hospital system provided about $158 million in uncompensated care during calendar year 2008. This figure includes unpaid medical debt, bills that the hospital wrote off for its poorest patients and discounts offered to uninsured patients, Smith said.

Saint Thomas Health Services, which operates Saint Thomas and Baptist hospitals, is owed $90 million in unpaid medical debt for services provided over the past three years, spokeswoman Rebecca Climer said.

This figure does not include what the hospital system has forgiven or provided free to patients who cannot pay, Climer said. The system is a part of Ascension Health, the largest not-for-profit health-care system in the nation.

The hospital has a fiscal responsibility to attempt to collect unpaid debt from those who can pay, Climer said.
Additional Facts

MEDICAL WOES LEAD TO MORE BANKRUPTCIES

As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem.
By contrast, a 2001 study found that illness or medical bills contributed to about half of bankruptcies.
And in 2007, 62.1% of all bankruptcies were caused by medical debt.

SOURCE: American Journal of Medicine study

http://www.tennessean.com/article/20090928/NEWS01/909270377/

Two unacceptable policy flaws

Panel Finishes Work on Health Bill Amendments

By Robert Pear and Jackie Calmes
The New York Times
October 2, 2009
Under Mr. Baucus’s bill, which would require most Americans to carry health insurance, “the consequence for not maintaining insurance would be an excise tax,” up to $1,900 a year for a family.
By a vote of 22 to 1, the committee adopted an amendment delaying and reducing that penalty. The maximum penalty for a family would start at $200 in 2014 and rise to $800 in 2017.
At the same time, the committee decided to exempt a greater number of people from the requirement to have coverage, known as an individual mandate. Under Mr. Baucus’s bill, people would have been exempt if they had to pay more than 10 percent of their adjusted gross income for the cheapest available insurance plan. The amendment lowers the threshold to 8 percent of income.
http://www.nytimes.com/2009/10/03/health/policy/03health.html?hp

And…

What Portion of Premiums Should Insurers Pay Out in Benefits?

By Uwe E. Reinhardt
The New York Times
October 2, 2009
In March 2008, the Council of Affordable Health Insurance took aim at state regulations that would require companies selling health insurance in the non-group market to spend at least 70 percent of collected premiums on direct health benefits — a fraction insurers call their “medical loss ratio,” also known as the “health benefit ratio.” In its March 2008 newsletter, the council wrote:
insurers need to have enough money to pay claims. In most states, individual coverage faces [medical] loss ratios between 55 and 65 percent.
On its Web site, the council describes itself as “a research and advocacy association of health insurance carriers active in the individual and small group market.” In effect, the organization tells us here that unless its member companies are allowed to burn 35 to 45 percent of premiums on marketing, broker commissions, administration, other expenses, and profits, they cannot thrive in the non-group market for health insurance.
It is a remarkable statement.
http://economix.blogs.nytimes.com/2009/10/02/what-portion-of-premiums-should-insurers-pay-out-in-benefits/

Two difficult issues that stem from using private health plans as the model for reform include: 1) Can you mandate individuals to buy an insurance plan they can’t afford?, and 2) Can you allow insurers free rein on using premium dollars for their own purposes rather than spending them on health care? Let’s see how the Senate Finance Committee approached these.
1) The concern should be about the affordability of health care, but the problem being addressed is the affordability of health plans. The committee has decided that the tier level plan that would be mandated for purchase would provide benefits with an actuarial value of 70 percent. That means that the individual would be responsible for the 30 percent balance, which can make actual health care unaffordable for many (even with subsidies and spending caps). Making plans more affordable makes health care less affordable (bad policy).
Many would decide that the premiums of these inadequate plans would still be more than they would want to pay. To force these individuals to buy the plans a financial penalty would be assessed on those who fail to do so. The closer the penalty is to the premium, the more likely it is for the individuals to buy the plan. The committee recognized that many of those who could not afford the premium would not be able to afford the penalty either. Thus a decision was made to reduce the penalty for non-compliance. Since the numbers who will decline to purchase insurance is inversely related to the amount of the penalty, many more will elect to pay the penalty and remain uninsured (bad policy).
Recognizing that many truly cannot afford the premium the committee decided to exempt those for whom the premium would exceed a given percentage of their income. It was recognized that, for many, 10 percent of income was still too high of a price for the cheapest plans, so the committee reduced that threshold to 8 percent. Lowering the threshold increases the numbers qualified for the exemption, leaving more individuals uninsured (bad policy).
2) Private health plans spend far too much of the premium on administrative services, leaving much less for spending on actual health care (a uniquely American approach to health care financing). Some of the proposed changes in regulation of the private insurers theoretically should reduce administrative spending, but there is no requirement for the insurers to do so.
Sen. Jay Rockefeller introduced an amendment that would limit insurers’ administrative spending to 15 percent of the premium so that 85 percent would have to be spent on health care. When you think of our horrendous level of health care spending, 15 percent is still an outrageous amount to remove from the health delivery system (bad policy). Yet both Republican and Democratic committee members were so incensed at the prospect that the government might tell the private insurance industry how it would have to spend its money, that Sen. Rockefeller had to withdraw his amendment. (Even Democrats believe that our money held in trust in an insurance risk pool somehow becomes the property of the insurer to do with as they please.)
Making people buy a product that they can’t afford and that wastes their health care dollars is really bad policy. Really, really bad. And there is absolutely no way that the House, or the Senate, or the Joint Conference Committee can change the framework of the private insurance model to make it work for all of us.
We can’t walk away from reform, but we need to dump this turkey and move on with an improved Medicare for all. That’s the change in policy direction that we need. Change we can believe in.
http://economix.blogs.nytimes.com/2009/10/02/what-portion-of-premiums-should-insurers-pay-out-in-benefits/#more-34243

Two unacceptable policy flaws

Panel Finishes Work on Health Bill Amendments

By Robert Pear and Jackie Calmes
The New York Times
October 2, 2009

Under Mr. Baucus’s bill, which would require most Americans to carry health insurance, “the consequence for not maintaining insurance would be an excise tax,” up to $1,900 a year for a family.

By a vote of 22 to 1, the committee adopted an amendment delaying and reducing that penalty. The maximum penalty for a family would start at $200 in 2014 and rise to $800 in 2017.

At the same time, the committee decided to exempt a greater number of people from the requirement to have coverage, known as an individual mandate. Under Mr. Baucus’s bill, people would have been exempt if they had to pay more than 10 percent of their adjusted gross income for the cheapest available insurance plan. The amendment lowers the threshold to 8 percent of income.

http://www.nytimes.com/2009/10/03/health/policy/03health.html?hp

And…

What Portion of Premiums Should Insurers Pay Out in Benefits?

By Uwe E. Reinhardt
The New York Times
October 2, 2009

In March 2008, the Council of Affordable Health Insurance took aim at state regulations that would require companies selling health insurance in the non-group market to spend at least 70 percent of collected premiums on direct health benefits — a fraction insurers call their “medical loss ratio,” also known as the “health benefit ratio.” In its March 2008 newsletter, the council wrote:

insurers need to have enough money to pay claims. In most states, individual coverage faces [medical] loss ratios between 55 and 65 percent.

On its Web site, the council describes itself as “a research and advocacy association of health insurance carriers active in the individual and small group market.” In effect, the organization tells us here that unless its member companies are allowed to burn 35 to 45 percent of premiums on marketing, broker commissions, administration, other expenses, and profits, they cannot thrive in the non-group market for health insurance.

It is a remarkable statement.

Comment:

By Don McCanne, MD

http://economix.blogs.nytimes.com/2009/10/02/what-portion-of-premiums-should-insurers-pay-out-in-benefits/#more-34243

Two difficult issues that stem from using private health plans as the model for reform include: 1) Can you mandate individuals to buy an insurance plan they can’t afford?, and 2) Can you allow insurers free rein on using premium dollars for their own purposes rather than spending them on health care? Let’s see how the Senate Finance Committee approached these.

1) The concern should be about the affordability of health care, but the problem being addressed is the affordability of health plans. The committee has decided that the tier level plan that would be mandated for purchase would provide benefits with an actuarial value of 70 percent. That means that the individual would be responsible for the 30 percent balance, which can make actual health care unaffordable for many (even with subsidies and spending caps). Making plans more affordable makes health care less affordable (bad policy).

Many would decide that the premiums of these inadequate plans would still be more than they would want to pay. To force these individuals to buy the plans a financial penalty would be assessed on those who fail to do so. The closer the penalty is to the premium, the more likely it is for the individuals to buy the plan. The committee recognized that many of those who could not afford the premium would not be able to afford the penalty either. Thus a decision was made to reduce the penalty for non-compliance. Since the numbers who will decline to purchase insurance is inversely related to the amount of the penalty, many more will elect to pay the penalty and remain uninsured (bad policy).

Recognizing that many truly cannot afford the premium the committee decided to exempt those for whom the premium would exceed a given percentage of their income. It was recognized that, for many, 10 percent of income was still too high of a price for the cheapest plans, so the committee reduced that threshold to 8 percent. Lowering the threshold increases the numbers qualified for the exemption, leaving more individuals uninsured (bad policy).

2) Private health plans spend far too much of the premium on administrative services, leaving much less for spending on actual health care (a uniquely American approach to health care financing). Some of the proposed changes in regulation of the private insurers theoretically should reduce administrative spending, but there is no requirement for the insurers to do so.

Sen. Jay Rockefeller introduced an amendment that would limit insurers’ administrative spending to 15 percent of the premium so that 85 percent would have to be spent on health care. When you think of our horrendous level of health care spending, 15 percent is still an outrageous amount to remove from the health delivery system (bad policy). Yet both Republican and Democratic committee members were so incensed at the prospect that the government might tell the private insurance industry how it would have to spend its money, that Sen. Rockefeller had to withdraw his amendment. (Even Democrats believe that our money held in trust in an insurance risk pool somehow becomes the property of the insurer to do with as they please.)

Making people buy a product that they can’t afford and that wastes their health care dollars is really bad policy. Really, really bad. And there is absolutely no way that the House, or the Senate, or the Joint Conference Committee can change the framework of the private insurance model to make it work for all of us.

We can’t walk away from reform, but we need to dump this turkey and move on with an improved Medicare for all. That’s the change in policy direction that we need. Change we can believe in.

The Case for Busting the FilibusterBusting

By Thomas Geoghegan
The Nation, August 12, 2009

This past spring, Senator Claire McCaskill wrote to me asking for $50 to help elect more Democrats, so we could have a filibuster-proof Senate. Now that Al Franken has finally been declared the sixtieth Democratic senator, her plea may seem moot. But even with Franken in office, we don’t have a filibuster-proof Senate. To get to sixty on the Democratic side, we’ll still have to cut deals with Democrats like Max Baucus, Ben Nelson and others who cat around as Blue Dogs from vote to vote. Whether or not Senator Arlen Specter is a Democrat, the real Democrats will still have to cut the same deals to get sixty votes.

Against his better judgment, Thomas Geoghegan has a website with his other complaints, including a petition demanding that the US Senate cloture the filibuster forever.

Maybe we loyal Dems should start sending postcards like the following: “Dear Senator: Why do you keep asking for my money? You’ve already got the fifty-one votes you need to get rid of the filibuster rule.” It’s true–McCaskill and her colleagues could get rid of it tomorrow. Then we really would have a Democratic Senate, like our Democratic House.

She won’t. The Democratic Senatorial Campaign Committee, which paid for her appeal, won’t. They use the filibuster threat to hit us up for money. And as long as they do, you and I will keep on kicking in for a “filibuster-proof” Senate, which, with or without Franken, will never exist. Every Obama initiative will teeter around sixty, only the deal-cutting will go on deeper in the back rooms and be less transparent than before.

In the meantime, playing it straighter than Claude Rains, McCaskill and other Democrats tell us how shocked, yes, shocked they are that this deal-cutting is going on. May I quote her spring letter? “I’m writing to you today because President Obama’s agenda is in serious jeopardy…”

It still is, as long as it takes sixty and not fifty-one votes to pass Obama’s bills. But no, here’s what she says: “Why? Because Republicans in the Senate–the same ones who spent years kowtowing to George W. Bush–are determined to block each and every one of President Obama’s initiatives.”

But why is that a surprise, if there’s a rule that lets forty-one senators block a bill? The surprise to people in other countries is that the Senate, already wildly malapportioned, with two senators from every state no matter how big or small the population, does not observe majority rule. Her next line:

“It’s appalling really.”

It sure is–the way she and other Democratic senators keep the filibuster in place. But let her go on:

“They’re the ones who got us into this mess. Now they want to stand in the way of every positive thing the President tries to do to set things right. I’m sure it frustrates you as much as it does me.”

Yes, Senator, it frustrates me. But Democratic senators who let this happen and then ask for my money frustrate me even more.

As a labor lawyer, I have seen the Senate filibuster kill labor law reform–kill the right to join a union, freely and fairly–in 1978 and 1994. And, no doubt, in 2010.

And in the end, all we get is a letter from Senator McCaskill asking for more money. Of course, I know there are all sorts of arguments made for the filibuster. For example: “But the filibuster is part of our country’s history, and there’s much to be said for respecting our history and tradition.” Yes, well, slavery and segregation are also part of our history, and that’s what the filibuster was used to defend. I’m all in favor of history and tradition, but I see no reason to go on cherishing either the filibuster or the Confederate flag.

Besides, that’s not the filibuster we’re dealing with.

The post-1975 procedural filibuster is entirely unlike the old filibuster, the one Mr. Smith, as played by the unshaven Jimmy Stewart, stayed up all night to mount in his plea for honest government (though usually it was Senator Bullhorn defending Jim Crow). The old filibuster that you and I and Frank Capra and the Confederacy love so much was very rare, and now it’s extinct. No one has stood up and read recipes for Campbell’s Soup for decades. In 1975 Vice President Nelson Rockefeller, in his role as president of the Senate, ruled that just fifty-one senators could vote to get rid of the filibuster entirely. A simple majority of liberals could now force change on a frightened old guard. But instead of dumping the filibuster once and for all, the liberals, unsure of their support, agreed to a “reformed” Rule 22. It was this reform that, by accident, turned the once-in-a-blue-moon filibuster into something that happens all the time. The idea was to reduce the votes needed to cut off debate from sixty-seven, which on the Hill is a big hill to climb, to just sixty. Liberals like Walter Mondale wanted to make it easier to push through civil rights and other progressive legislation. What’s the harm in that?

The only problem is that, because the filibuster had rendered the chamber so laughable, with renegade members pulling all-nighters and blocking all the Senate’s business, the “reformers” came up with a new procedural filibuster–the polite filibuster, the Bob Dole filibuster–to replace the cruder old-fashioned filibuster of Senate pirates like Strom Thurmond (“filibuster” comes from the Dutch word for freebooter, or pirate). The liberals of 1975 thought they could banish the dark Furies of American history, but they wound up spawning more demons than we’d ever seen before. Because the senators did not want to be laughed at by stand-up comedians, they ended their own stand-up acts with a rule that says, essentially:

“We aren’t going to let the Senate pirates hold up business anymore. >From now on, if those people want to filibuster, they can do it offstage. They can just file a motion that they want debate to continue on this measure indefinitely. We will then put the measure aside, and go back to it only if we get the sixty votes to cut off this not-really-happening debate.”

In other words, the opposing senators don’t have the stomach to stand up and read the chicken soup recipes. We call it the “procedural” filibuster, but what we really mean is the “pretend” filibuster.

But the procedural, or pretend, filibuster is an even worse form of piracy, an open invitation to senatorial predators to prey on neutral shipping, to which they might have given safe passage before. After all, why not “filibuster” if it’s a freebie–if you don’t actually have to stand up and talk in the chamber until you’re not only half dead from exhaustion but have made yourself a laughingstock? That’s what post-1975 senators began to do. In the 1960s, before the procedural filibuster, there were seven or fewer “old” filibusters in an entire term. In the most recent Senate term, there were 138.

At least with the old filibuster, we knew who was doing the filibustering. With the modern filibuster, senators can hold up bills without the public ever finding out their names. No one’s accountable for obstructing. No senator runs the risk of looking like a fool. But while they’re up there concealing one another’s identity, the Republic is a shambles. And now, with a nominal sixty Democratic votes, the need for secrecy as to who has put everything on hold may be even greater than before.

“But just wait till 2010, when we get sixty-two or sixty-three Democrats.” I’m sure that’s what Senator McCaskill would tell me. “So come on, kick in.” But Senator, where will they come from? They could come from bloody border states like yours (Missouri), or from deep inside the South. The problem with the filibuster is not so much that it puts Republicans in control but that it puts senators from conservative regions like the South, the border states and the Great Plains in control. The only true filibuster-proof Senate would be a majority th
at would be proof against those regions.

An astute book published in 2006, Thomas Schaller’s Whistling Past Dixie, argued that to craft a presidential majority Democrats don’t need the Southern vote. That may be true (although it turned out that Barack Obama made historic inroads in the South, winning three states there). But there is no way to whistle past Dixie when a non-Dixie presidential majority tries to get its program through the Senate. After 2010, we could have sixty-four Democrats in the Senate and still be in bad shape.

A filibuster-proof Senate, then, is a conceptual impossibility. Even with a hundred Democrats, a filibuster would still lock in a form of minority rule. Because among the Democrats there would arise two new subparties, with forty-one senators named “Baucus” blocking fifty-nine senators named “Brown.”

Here’s another argument for the filibuster: “If we get rid of it, we’ll be powerless against the Republicans when they’re in charge.” That’s why we need it, they say: we’re waiting for the barbarians, for the nightmare of President Palin. People in the AFL-CIO tell me this even as the filibuster keeps the right to organize a union on ice and union membership keeps shrinking.

Or as a union general counsel said to me: “Everyone here in the DC office would be freaked out completely if we lost the filibuster. They think it’s the only thing that saved us from Bush.” Inside the Beltway, they all think it’s the filibuster that saved those of us who read Paul Krugman from being shipped off to Guantánamo. Really, that’s what many people on the left think. “If Bush ever came back, we’d need it.”

Of course Bush, or a Bush equivalent, will come back–precisely because Obama and our side will be blocked by the filibuster. Obama is in peril until he gets the same constitutional power that FDR had, i.e., the right to pass a program with a simple majority (at least after Senator Huey Long finally ran out of words). But let’s deal with the canard that the filibuster “saved” us from Bush. What’s the evidence? Judicial nominations: that’s the answer they give. Go ahead, name someone we blocked. Roberts? Alito? Of course there’s Bork, whom we blocked in the 1980s. But we didn’t block him with a filibuster.

Think seriously about whom we really stopped. Look, I’m all in favor of opposing atrocious right-wing nominations, and I admit that the filibuster, or at least the GOP’s refusal to nuke it, did keep some appellate and district courts free of especially bad people. But I can tell you as a lawyer who does appellate work, who has to appear before these judges, it makes little difference to me if we lose the filibuster. All it means is that instead of a bad conservative, I end up with a really bad conservative. Either way, I still wind up losing.

I think I can say this on behalf of many liberal lawyers who appear before appellate courts: if we could give up the filibuster and get labor law reform or national health insurance, I’d put up with a slightly more disagreeable group of right-wing judges. We’ll take the heat.

The fact is, as long as we have the filibuster, we ensure the discrediting of the Democratic Party and we’re more likely, not less, to have a terrible bench.

Sure, sometimes liberal Democrats put the filibuster to good use when Republicans are in power. Sure, sometimes a liberal senator can use the filibuster to stop a piece of corporate piracy. It’s impossible to prove that the filibuster never does any good. But the record is awfully thin. Look at all the financial deregulation that Senator Phil Gramm and leading Democrats like Larry Summers pushed through only a decade ago. The filibuster did not stop their effective repeal of the New Deal, but it would block the revival of it today.

On the other hand, Republicans and conservative Democrats use their filibusters on labor, health, the stimulus, everything. They can and will block all the change that Obama wanted us to believe in. And even when they lose, they win. For example, when we say that after a major rewriting of the stimulus package–a rewriting that seriously weakened the original bill–it “survived the filibuster,” what we really mean is that it didn’t.

But let’s turn to the final objection: “No one in Washington cares about this. It’s not on the agenda. It’s a waste of time even to discuss it. What you’re talking about is impossible.”

What Washington insiders partly mean when they say this is, With a filibuster, any senator can stick up the Senate, and what senator is going to turn in his or her sidearm by giving up the right to demand sixty votes? That’s why they’re raising a million dollars a day. Otherwise, they’d be peacefully serving in the House. The right to filibuster is what makes each of them a small-town sheriff. That’s why it would take massive marches in the streets to force them to give it up.

Indeed, it’s hard to imagine how bloody the battle would be. The last time anything so traumatic happened on the Hill was in 1961, when the bigger procedural bar to majority rule was not in the Senate but the House. John Kennedy had just come in, and it was clear that his New Frontier program (we still didn’t have Medicare) would go nowhere because of the power of the House Rules Committee chair, the now forgotten “Judge” Howard Smith. Kennedy had to enlist the Speaker of the House, Sam Rayburn, to break Smith’s power to stop any bill he disliked from leaving House Rules. In the end, the battle to beat Smith probably killed Rayburn, who died later in the year.

It was an awful power struggle, and many were aghast that Kennedy had thrown away all his capital for this cause. But had he not done it, there probably would not have been a Civil Rights Bill, or certainly not the full-blown version of the Great Society that Lyndon Johnson pushed through after Kennedy’s assassination. Imagine having to fight the battle for Medicare today. Without that war on Judge Smith, what we now call the “liberal hour” would not have come.

Nor will any “liberal hour” come in our time, until we bring the filibuster down. I know it seems hopeless. But so did knocking out slavery when the abolitionists first started, or segregation, when civil rights activists began their struggle against Jim Crow. It’s a fair enough analogy, since the filibuster is one of the last remnants of racist politics in America: it was a parliamentary tactic used by the Calhounians to make extra certain slavery would stay around.

We should adopt the strategy of the antislavery movement, which in the early stages had three approaches:

1. The laying of petitions on the House. Forgive the archaic legal phrase: I mean petitions to Congress, both houses. In the era of John Quincy Adams–in case you missed the Steven Spielberg movie–there would be mass petitions, with Adams and others reading them on the House floor to the howls of the Southerners. Every group busted by a filibuster should lay on a petition. And start with the House, which is the only place it has a chance of being read.

2. Resolutions by the House, as a warm-up for the Senate. Such resolutions might read: “Resolved, that Congress has no authority to require supermajorities in any chamber except as authorized by the Constitution.” Aren’t House chairs tired of seeing their bills cast into black holes by senators whose names they never even know?

3. Evangelizing. The most effective tactic in the fight against slavery was the preaching of New England clergy against it. We can start in our battle against the filibuster by enlisting faculty at New England colleges to hold teach-ins. Teach the kids why “Yes, we can” can’t happen with the current Senate rules.

By the way, the abolitionists knew the Senate was their enemy, just as it is our enemy today. Let’s hope these tactics work for us in getting rid of this last vestige of slavery: Senate Rule 22. What’s painful is that we have to cross some of our most sainted se
nators. But unless we decide to just give up on the Republic, there’s no way out. To save the Obama presidency, we may have to fight our heroes.

About Thomas Geoghegan
Thomas Geoghegan, a lawyer in Chicago, is the author of In America’s Court: How a Civil Lawyer Who Likes to Settle Stumbled Into a Criminal Trial and Which Side AreYou On? Trying to Be for Labor When It’s Flat on Its Back (both New Press)

This article appeared in the August 31, 2009 edition of The Nation.

Will the insurance exchange be as effective as FEHBP?

Employees Face Big Hike in Health-Care Costs

By Steve Vogel
The Washington Post
Federal Diary
September 30, 2009
Employees enrolled in the Federal Employees Health Benefits Program will pay an average 8.8 percent more in health-care costs, according to figures released by the Office of Personnel Management.
Blue Cross Blue Shield rates will increase 15 percent for self-only coverage and 12 percent for family coverage, the company said. Enrollees will have to pay more thanks to a wider range of benefits and the company’s wide network of providers, said Jena Estes, vice president of Blue Cross Blue Shield’s federal employee program.
“We have a very strong commitment to managing the costs and managing that trend. You’ll see a real strong focus on coordinating the care and managing the total care,” Estes said.
“This is an enormous increase that erodes federal employees’ standard of living,” Colleen M. Kelley, president of the National Treasury Employees Union, said in a statement.
The American Federation of Government Employees expressed “grave concern” at the news. “FEHBP is getting more and more unaffordable for more people,” said Jacqueline Simon, AFGE public policy director.
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/29/AR2009092903539.html

Members of Congress are promising reform that will give us choices of coverage, just like they have in the Federal Employees Health Benefits Program (FEHBP). They will do this by establishing an FEHBP-like insurance exchange for the purchase of health plans.
Blue Cross Blue Shield is the most popular program selected by federal employees. They promise to continue with their “very strong commitment to managing the costs.” And how well are they doing? This year’s rate increases are 15 percent for individuals and 12 percent for families.
FEHBP, as an example of an insurance exchange, is proof that a financing system based on private insurance plans is an obsolete model that “is getting more and more unaffordable for more people.” Yet Congress is moving forward with this model.
What about a government financing system? At the Senate Finance markup yesterday, when asked by Sen. Chuck Schumer if Medicare is a good program, Sen. Chuck Grassley replied, “I think that Medicare is part of the social fabric of America.” But then he said that government is not a fair competitor, “it’s a predator.”
Ask federal employees insured by Blue Cross Blue Shield whom they think the predator is. Then ask Medicare beneficiaries.
Medicare should be a part of the social fabric that weaves all of us into its egalitarian patterns, forming an indestructible fabric based on social solidarity.

Will the insurance exchange be as effective as FEHBP?

Employees Face Big Hike in Health-Care Costs

By Steve Vogel
The Washington Post
Federal Diary
September 30, 2009

Employees enrolled in the Federal Employees Health Benefits Program will pay an average 8.8 percent more in health-care costs, according to figures released by the Office of Personnel Management.

Blue Cross Blue Shield rates will increase 15 percent for self-only coverage and 12 percent for family coverage, the company said. Enrollees will have to pay more thanks to a wider range of benefits and the company’s wide network of providers, said Jena Estes, vice president of Blue Cross Blue Shield’s federal employee program.

“We have a very strong commitment to managing the costs and managing that trend. You’ll see a real strong focus on coordinating the care and managing the total care,” Estes said.

“This is an enormous increase that erodes federal employees’ standard of living,” Colleen M. Kelley, president of the National Treasury Employees Union, said in a statement.

The American Federation of Government Employees expressed “grave concern” at the news. “FEHBP is getting more and more unaffordable for more people,” said Jacqueline Simon, AFGE public policy director.

http://www.washingtonpost.com/wp-dyn/content/article/2009/09/29/AR2009092903539.html

Comment:

By Don McCanne, MD

Members of Congress are promising reform that will give us choices of coverage, just like they have in the Federal Employees Health Benefits Program (FEHBP). They will do this by establishing an FEHBP-like insurance exchange for the purchase of health plans.

Blue Cross Blue Shield is the most popular program selected by federal employees. They promise to continue with their “very strong commitment to managing the costs.” And how well are they doing? This year’s rate increases are 15 percent for individuals and 12 percent for families.

FEHBP, as an example of an insurance exchange, is proof that a financing system based on private insurance plans is an obsolete model that “is getting more and more unaffordable for more people.” Yet Congress is moving forward with this model.

What about a government financing system? At the Senate Finance markup yesterday, when asked by Sen. Chuck Schumer if Medicare is a good program, Sen. Chuck Grassley replied, “I think that Medicare is part of the social fabric of America.” But then he said that government is not a fair competitor, “it’s a predator.”

Ask federal employees insured by Blue Cross Blue Shield whom they think the predator is. Then ask Medicare beneficiaries.

Medicare should be a part of the social fabric that weaves all of us into its egalitarian patterns, forming an indestructible fabric based on social solidarity.

Are physicians fleeing Medicare?

Utilization Trends Indicate Sustained Beneficiary Access with High and Growing Levels of Service in Some Areas of the Nation

Medicare Physician Services
GAO
August 2009
GAO found that Medicare beneficiaries experienced few problems accessing physician services during its period of study. Very small percentages of Medicare beneficiaries–less than 3 percent–reported major difficulties accessing physician services in 2007 and 2008. The proportion of beneficiaries who received physician services and the number of services per beneficiary served increased nationwide from April 2000 to April 2008. Indicators of physician willingness to serve Medicare beneficiaries and to accept Medicare fees as payments in full also rose from 2000 to 2008.
http://www.gao.gov/new.items/d09559.pdf

In the debate on health care reform we hear that physicians are leaving the Medicare program because they cannot continue to accept the low fees paid by the government. Not true, according to this new GAO report. Physicians are more willing to serve Medicare beneficiaries and to accept Medicare fees as payments in full.
Some might use this finding to support a public option paying Medicare rates, but it is a much more powerful argument when used in support of a single payer, Medicare for all, national health program. Unlike the private insurance plans, Medicare pays enough, but not too much, though appropriate revisions are a continuing work in progress – as it should be.

The Single Payer Solution For Health Care Reform

The Chattanoogan
Posted September 25, 2009

An open letter to Senator Corker, Senator Alexander and Representative Wamp:

Honorable Elected Officials:

I’ve spent considerable time reviewing the experience of other countries and states within our country, and am disappointed that the for-profit health insurance industry has defined the debate, to the detriment of an affordable, workable solution.

I’m an advocate of the best of capitalism and a free market for most commodities. However, health care is not in the same category as a bushel of corn or an automobile. A health care delivery system that is designed to maximize profit will never deliver the ultimate objective: affordable, universal access to quality health care.

Americans currently spend twice per capita ($7,000 per year) on health care as most other industrialized nations. We’re currently paying more than enough for universal quality health care, but are not getting it.

Our health care outcomes are poorer than other countries, and we continue to leave millions with inadequate care.

Health care costs are a leading cause of personal bankruptcy. It is imperative that we get health care costs under control.

All plans currently under serious consideration in the U.S. Senate and House lack a single payer financing mechanism. Therefore, all these proposals will require large tax increases over the long term.

Plans such as that proposed by Max Baucus would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment.

Single-payer health reform solutions have been introduced into both the U.S. Senate and House.

A “single payer” method of collecting and distributing payments for medical services leaves the delivery of medical care in the hands of the private sector. It is not “socialized medicine” like our military health care system, but is “socialized insurance” like our Medicare program. This approach is endorsed by Physicians for a National Health Program (PNHP.org), with 17,000 members nationwide.

S703, the American Health Security Act of 2009, is unlike other proposals.

This proposal would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles while allowing free choice of physician. It is the most fiscally conservative option for reform.

Single payer slashes private insurance overhead and bureaucracy in medical settings, saving approximately $400 billion annually that can be redirected into clinical care.

Highlights of the bill include the following:

Patients go to any doctor or hospital of their choice. By eliminating the high overhead and profits of the private, investor-owned health insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves $400 billion annually – enough money to provide comprehensive, quality care to all. Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.
The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses. While federally funded, the program is to be administered by the states.

A similar single payer bill, HR 676 (Expanded and Improved Medicare for All) has over 80 co-sponsors in the House.

An article published in the New England Journal of Medicine showed that over 30% of health spending in the U.S. is consumed by administrative cost – nearly double what Canada spends. If we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 Billion annually. This savings would allow the U.S. to provide comprehensive, quality health care coverage to all our citizens, while eliminating premiums, business subsidies, deductibles and co-pays.

By simplifying its payment system, Canada has cut insurance overhead to 1% of premiums (1/20th of Aetna’s overhead) and eliminated expensive paperwork for doctors and hospitals.

A “public plan option” will not realize such savings. Incremental tinkering with private for-profit health insurance will not ultimately control costs. States have tried individual mandate plans and found them not to work.

Single payer is not a panacea. However, without it we will never reach the imperative of providing universal access to quality health care.

It’s time to give the for-profit health insurance companies their pink slip, and provide retraining for their employees who will be displaced.

I recommend you watch an excellent documentary titled Health, Money and Fear.

It addresses the many drivers behind escalating health care costs.

This film was produced by an emergency room physician, and features the former governor of Oregon, Harvard physicians and the former editor of the New England Journal of Medicine among others.

Thanks for your financially responsible leadership on this critical issue.

Matthew Hine, M.D., M.P.H.
Fellow, American College of Preventive Medicine
Member, Physicians for a National Health Program

Sit-in today at Aetna office in New York to demand an end to insurance company abuse

19 citizens and health care providers arrested, launching national mobilization for health care for all

FOR IMMEDIATE RELEASE: 09/29/2009

Contact:
Lacy MacAuley, (202) 445-4692, lacy@massey-media.com
Katie Robbins, Healthcare-NOW! (330) 618-6379, info@healthcare-now.org
Follow us on Twitter @mob4healthcare

New York, NY — Citizens and health care providers today staged a sit-in at the offices of Aetna, one of the nation’s largest health insurance companies, in New York City (99 Park Ave @40th. The action is part of a national mobilization to end health insurance abuses such as the denial of coverage for lifesaving treatments, and win support for the only real public option — Medicare for all, a single payer plan. The action was part of a Mobilization for Health Care for All campaign that includes actions in Chicago, Los Angeles, and other cities across the country.

VIDEO: View a video of today’s sit-in on our YouTube channel

http://www.gettyimages.com/detail/91239218/Getty-Images-News

The 19 participants, wearing T-shirts with slogans that read “Medicare for All” and chanting “patients, not profits!” linked arms and sat down in the lobby of the Aetna building, prompting Aetna employees to step around them on their way into their offices, where insurance claim reviewers are busy looking for ways to deny people the lifesaving treatment that they need. A crowd of supporters picketing outside the building held signs that said “Aetna is the real death panel,” and “Single payer now.”

Participants in the action demanded that the insurance company immediately approve all doctor-recommended lifesaving treatments in their files, stating that they would not leave until Aetna approved care. Aetna, however, refused to meet with their representative.

“Insurance companies are denying care to people who need it right and left, but that’s not how it should work. Health care is a right, not a privilege,” said Constancia ‘Dinky’ Romily, 68, just before getting arrested. Romily is a retired nurse and a resident of East Village, New York. “I’m putting myself on the line and getting arrested to end insurance abuse and win health care for all,” she says.

The sit-in is part of the Patients Not Profit campaign of the Mobilization for Health Care for All. The mobilization was launched by the organizations Prosperity Agenda, Health Care NOW!, and the Center for the Working Poor. Today’s action has been organized by the Private Health Insurance Must Go coalition, a local New York organization.

“People are dying because these corporations put profits before patients, and the health care bill currently on the floor of Congress fails to address the real cause of the health care crisis — the insurance companies.” says Katie Robbins, an organizer with Healthcare-Now! “The only solution to our health care crisis is the real public option, Medicare for All, a single payer plan.”

Laurie Wen, 38, a Manhattan resident, is one of the everyday Americans who are fed up with the state of health care in our country, and was arrested today to stand up for the hundreds of Americans who are denied lifesaving care every day, and to call for the only solution for health care for all, Medicare for all. A friend of hers, she says, was recently denied by Aetna for coverage for a bone marrow transfusion to treat cancer for three months, setting his care back for three months.

“We will continue to stage these sit-ins as Congress debates legislation that expands the insurance company stranglehold over our health, our lives, and our government,” says Wen. “We need a better system to end insurance abuse and win health care for all.”

# # #

For more information:
Mobilization for Health Care www.MobilizeForHealthCare.org
Health Care NOW!, www.healthcare-now.org
Prosperity Agenda, www.ProsperityAgenda,US
Center for Working Poor, http://centerfortheworkingpoor.org
Private Health Insurance Must Go coalition, www.phimg.org
http://www.youtube.com/mobilize4healthcare

Why the Current Bills Don't Solve Our Health Care Crisis

By Michael Moore
Huffington Post
Posted: September 29, 2009

Co-authored with Rose Ann DeMoro, executive director, California Nurses Association/National Nurses Organizing Committee

Now we know why they’ve stopped calling this health care reform, and started calling it insurance reform. The current bills advancing in Congress look more like rearranging the deck chairs on the insurance Titanic than actually ending our long health care nightmare.

Some laudable elements are in various versions of the bills, especially expanding Medicaid, cutting the private insurance-padding waste of Medicare Advantage, and limiting the ability of the insurance giants to ban and dump people who have been or who ever will be sick.

But, overall, the leading bills and the President’s proposal are, like the dog that didn’t bark, more notable for what is missing.

Here are 13 problems with the current health care bills (partial list):

1. No cost controls on insurance companies. The coming sharp increases in premiums, deductibles, co-pays, co-insurance, etc. will quickly outpace any projected protections from caps on out-of-pocket costs.

2. Insurance companies will continue to be able to use marketing techniques to cherry-pick healthier, less costly enrollees.

3. No restrictions on insurance denials of care that insurers don’t want to pay for. In case you missed it, the California Nurses Association/National Nurses Organizing Committee uncovered data on the California Department of Managed Care website recently that found six of the biggest California insurers rejected, on annual average, more than one-fifth of all claims every year since 2002.

4. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas, where one or two companies dominate, severely limiting choice and competition.

5. A massive government bailout for the insurance industry through the combination of the individual mandate requiring everyone not covered to buy insurance, public subsidies which go for buying insurance, no regulation on what insurers can charge, and no restrictions on their ability to decide what claims to pay.

6. No controls on drug prices. The White House deal with Big Pharma, which won bipartisan approval in the Senate Finance Committee, opposes the use of government leverage to negotiate real cost controls on inflated drug prices.

7. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay.

8. Tax on comprehensive insurance plans. That will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of bare-bones, high-deductible plans, and lead to more self-rationing of care and medical bankruptcies.

9. Not universal. Some people will remain uncovered, including those exempted, and undocumented workers, denying them treatment, exposing everyone to communicable diseases and inflating health care costs.

10. No definition of covered benefits.

11. No protection for our public safety net. Public hospitals and clinics will continue to be under-funded and a dumping ground for those the private system doesn’t want. Public monies going to hospitals serving low-income communities will be shifted to subsidies for private insurance.

12. Long delay in implementation. Many reforms don’t go into effect until 2013.

13. Nothing changes in basic structure of the system; health care remains a privilege, not a right.

We may be slow learners, but the rest of the industrial world has figured it out: Universal, single-payer or national health care systems. That’s the reason why all those other countries cover everyone, have better patient outcomes, cause no one to declare bankruptcy or lose their homes because of medical bills, and spend less than half per capita on health care than we do.

We could do it too, by reducing the starting age for Medicare from 65 to 0. There’s still time to act.

Call on your Congress member to support the vote coming up on the House floor on the Anthony Weiner amendment to protect, expand and improve Medicare for All. Senators have the same opportunity in a vote on Senate bill 703, being offered as a floor amendment by Senator Bernie Sanders.

Democrats must also ensure that whatever bill passes includes a provision enabling states to set up their own single-payer systems. These votes are the true litmus tests of the Democrats’ commitment to guaranteeing health care for all, and finally solving our health care crisis.