Cheaper rates cause debate

By Barry Brown
Washington Times
Thursday, June 11, 2009

TORONTO | For a Canadian facing emergency surgery in the United States, a ride on a privately chartered Lear jet back to Canada is a whole lot cheaper than having the operation in a U.S. hospital.

Canada’s universal health care system will pay for urgent medical care outside the country, but at Canadian rates of about $360 a day for a hospital stay.

That compares with daily rates of up to $5,000 to $6,000 a day in Florida, where tens of thousands of well-to-do Canadian retirees spend each winter.

Before stepping across the border, “the first thing a Canadian thinks about is supplemental health insurance,” said Michael MacKenzie, a spokesman for the Canadian Snowbird Association, which represents about 80,000 migratory citizens from the land of ice and snow.

No wonder President Obama’s plan to expand American health coverage to the uninsured has become such a hot topic north of the border.

If Mr. Obama succeeds, the U.S. could draw even more Canadian doctors and nurses to the U.S., exacerbating a shortage of medical professionals, said Dr. Brian Day, a Canadian health care critic and former head of the Canadian Medical Association.

If Mr. Obama fails, perhaps Canada could open its system to “medical tourism” from the U.S., Dr. Day said.

About 500,000 Americans annually travel to other counties such as India, Thailand and the Philippines for high-quality but much cheaper medical care, he said. Few of them go to Canada, where the notion of funding public hospitals with money from U.S. patients has been politically unacceptable.

The Canadian system insures everyone, and all Canadians have access to basic and critical health care without ever seeing a doctor or hospital bill.

Nevertheless, the demands on the system have led to waiting lists for treatments such as MRI scans, cataract and artery bypass surgeries and hip replacements.

That’s one reason why 70 percent of Canadians have some form of supplemental health insurance, whether or not they plan to visit the United States.

The Canadian system needs fixing, said Dr. Robert Ouellet, president of the Canadian Medical Association.

“We have improved waiting times from years to months in most areas, but people still wait too long even in emergency rooms,” he said.

Dr. Ouellet suggests that the U.S. look elsewhere for models of universal health care.

Both the U.S. and Canadian governments, he said, would do well to examine systems such as one in the Netherlands, which provides universal and broader-based health care through a small number of regulated, private health insurers and government funding at a slightly lower cost than in Canada.

Dr. Catherine Kurozu, a Canadian doctor who has been practicing obstetrics and gynecology in the U.S. and Guam for 13 years, said, “In Canada, there’s an egalitarian attitude I admire. Medical treatment in America depends almost entirely on what insurance company you have and what state you live in.

“In Massachusetts, you get four days in hospital after a C-section birth; in California it’s one day and out the door,” she said.

For Canadian Raymond McEwan, American hospitals are among the best in the world but are focused on making as much money as they can per patient, while in Canada the goal is good medical care for everyone.

In December, he was wintering in Port Richie, Fla., when he checked into a hospital with stomach cramps and pain.

“I’d worked in an auto repair shop for years so I knew all about insurance,” said Mr. McEwan, 68, who had a supplemental policy from a private company.

Over the next several hours, Mr. McEwan said, doctors and nurses came and went, he was given blood tests and an ultrasound and was moved from room to room. He said he was “terrified” that the hospital hadn’t contacted his insurance company: Would he be stuck with an American hospital bill?

Once diagnosed with an infected gallbladder, the hospital was all set to operate and possibly add some repairs to Mr. McEwan’s colon. Before that happened, the hospital apparently got around to notifying his private Canadian insurance company, which put an end to everything.

“A few hours later, I was strapped in a stretcher and my wife and I were on a Lear jet being flown back to Canada,” he said. There, the doctors confirmed the gallbladder infection, deadened the pain and successfully performed Mr. McEwan’s surgery four weeks later.

To save money, Mr. McEwan’s insurance company paid $20,000 for the private flight home and his brief stay in an American hospital.

Mr. MacKenzie of the Snowbird Association said it is not uncommon for U.S. hospital bills to top $100,000, especially when surgery is involved.

Once Mr. McEwan was back in Canada, his insurance company was relieved of responsibility because there are no hospital bills.

“In Canada, the first thing I was asked coming off the plane was, ‘Are you in pain?’ ” he said. In the American hospital, he said, he waited an hour in the emergency room and then five hours more in various rooms without ever being asked whether he needed pain relief.

“It seemed like everyone in the American hospital was working on commission and trying to get me to sign for this and that treatment,” he said. “In Canada, it’s not about making money.”

http://washingtontimes.com/news/2009/jun/11/canadas-health-plan-contrasted-with-us/

Editorial
Capital Times (Madison, WI)
6/10/2009

Dr. Linda Farley, the local physician and nationally recognized advocate for health care reform who died this week, had long championed the replacement of the current for-profit health care system with a single-payer plan. Such a plan would guarantee that all Americans have access to quality care while at the same time cutting costs associated with insurance and health care industry profiteering.

We have taken our counsel from Dr. Farley, and her husband, Dr. Gene Farley, on these issues for a number of years.

Our confidence in the experience and wisdom of these veteran physicians, who worked in a variety of public and private settings, has informed this newspaper’s commitment to the view that only a single-payer system will achieve the stated goals of President Barack Obama and congressional leaders. The Obama administration and Democrats and most Republicans in Congress say they want more and better care for all, with real flexibility for patients who want to keep the same doctor and genuine savings.

But we have also been informed over the years by Farley’s reminders that our current broken system does not merely make it harder for ailing Americans to get care and for healthy Americans to maintain their fitness. It also imposes incredible economic hardship on Americans who fall ill.

The extent of that hardship was revealed last week in a study that will be published this summer by the American Journal of Medicine. According to the study, medical problems contributed to almost 62.1 percent of all bankruptcies in 2007.

Worse yet, the data from the study show that, from 2001 to 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent.

That’s a particularly unsettling notion, as the current economic meltdown is all but sure to have caused an expansion of the crisis. Thus, as many as two-thirds of the 1.5 million Americans who are being forced into bankruptcy annually end up there because they made the “mistake” of getting sick.

And here is where things get downright scary. According to the study:

• Most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness.

• Most of the medically bankrupt fell into income categories that the authors of the study identify as “solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.

• In a substantial number of instances, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

“Our findings are frightening,” says Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy. For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain.”

Elizabeth Warren, the Leo Gottlieb professor of law at Harvard and one of the leading experts on personal bankruptcy, explains: “For many families, bankruptcy is a deeply shameful experience. People arrive at the bankruptcy courts exhausted — financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances.”

And more often than not, notes Warren, a co-author of the report, they arrive because they fell ill or suffered from a chronic condition.

Thus bankruptcy is not for the most part a matter of personal responsibility — or the lack thereof. It is a matter of bad health and a broken health care system.

How should we respond at a point when the United States is preparing to enter into another national health care debate?

Not with the gimmicks that members of Congress on both sides of the aisle and the Obama administration have been proposing, which leave most Americans in the grip of insurance companies that don’t provide adequate or humane coverage when people need it the most.

“We need to rethink health reform,” says Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., who is another co-author of the study. “Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance — stripped-down plans riddled with co-payments, deductibles and exclusions — won’t stem the rising tide of medical bankruptcy.”

Woolhandler is right.

Only the creation of a single-payer national health insurance system will address not just the health care crisis but the bankruptcy crisis.

As Dr. Linda Farley told us for years: “Single-payer is the cure.”

So how do we prescribe it?

The best way is by supporting the efforts of the group with which Farley was long associated: Physicians for a National Health Program, the real reform group that has won the support of more than 16,000 doctors nationwide.

To learn more about Physicians for a National Health Program, visit the group’s website at www.pnhp.org or call 312-782-6006.

http://www.madison.com/tct/opinion/454232

“Single-payer is the health system that works for every other industrialized nation on earth.”

By Sylvia Hampton
East County Magazine, California
6/16/09

Supporters of real health care reform want a national expansion of the popular Medicare single payer program now covering every American over age 65. But they are being told that it is just not “politically feasible.” When one asks “Why?” there is double talk and a run-around. The facts are clear. Oxen will be gored–and the industry and some in Congress are circling the wagons to protect their own self interests. We have some blatant conflicts of interest here that would make an eight-year-old blush: Congress members who have stock holdings in the industry and get large campaign contributions from insurers. Imagine that.

The insurance industry competes by selling large group insurance to businesses employing young healthy people. Ca-ching! They get those contracts by promising low cost to the employer, so the employee “contribution” becomes a pay deduction. Then if an employee gets sick or in an accident, his co-pays can become so large as to cause him to go bankrupt. But hey–no skin off the insurance company’s nose! Ca-ching.

If the sickness or injury is bad enough to lose your job they don’t have to mess with you anymore. They just drop you if you live long enough (after they do everything in their power to deny the claims.) After all, they have stockholders to think about–they must, by law, make a profit. Ca-ching. And because the drug companies don’t want to have to negotiate with the big bad government on prices, they stick with the captains of this industry like two peas in a private money pot. That’s what makes health insurance hooked to employment so darn great–for insurers. The result is that they have so much money they can scare the pants off everyone in government. They will run an ad campaign so slick a good guy will look like Satan when they are done.

Who gets the money for all those campaigns to sell insurance, sell drugs, sell the negative campaign ads? The Media. Ca-ching. So don’t ask them to help you gore that ox. That money talks–big time.

Single-payer is the health system that works for every other industrialized nation on Earth. Single-payer results in health statistics better than ours, costs the people far less than ours, and at the same time covers everyone in their country. But it was not given consideration in Congress and is deemed an evil communist plot by 30% of our population. The other 70% have caught on after hard knocks in our system and now support single payer/Medicare for all. But that is not even what the president is asking for; he just wants a “public option” in addition to the private plans.

But no, the industry says that is not fair. Why? Too many employers and workers will grab it in a heartbeat. Why? Better, cheaper, faster, nicer and more complete–like what all of us over 65 have and love: Medicare. The modern robber barons are throwing so much money and weight around Washington D.C. right now that you ordinary people out here in the real world don’t have a chance.

There is only one way you young ‘uns will get what I have–and that is to take to the streets and demand it. Call your congressman, demonstrate in the street by his office, call the talk shows, and scream bloody murder. Because murder is what is happening to you right now. They are killing you. But as long as insurers, drug companies and legislators make a profit and you don’t pay attention, their life goes on.

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Sylvia Hampton is the past director of Health Care for All CA and a current board member of San Diegans for Health Care Coverage.

The views expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. If you wish to submit an editorial for consideration, contact editor@eastcountymagazine.org.

Letters
The Washington Post
Monday, June 15, 2009

Dana Milbank’s description of the recent congressional hearing on single-payer health care [“It’s Healthy to Vent,” June 11] was polemical.

First, many attendees were congressional staff members, not single-payer advocates.

Second, to describe the testimony of witnesses, which included Rep. John Conyers Jr., chairman of the House Judiciary Committee, as mere “venting” and “an exercise in blowing off steam” was offensive to the millions of Americans whose views they represent.

Third, Rep. Dennis Kucinich’s grilling of the Manhattan Institute’s David Gratzer was justified by Mr. Gratzer’s selective use of statistics to portray a falsely grim picture of the Canadian single-payer system. Certainly, a national system of health insurance that guarantees comprehensive access to needed care and eliminates profit is anathema to someone who cheerleads the intellectually and morally bankrupt “consumer-driven health care” movement.

Finally, to decry a national system of health-care financing that retains the private delivery of health care as socialism simply plays into the propaganda and fear-mongering of the right and the private insurance lobby, which opposes any challenge to its obscene profits.

Make no mistake: Single-payer advocates have much to be upset about, given our near-complete exclusion from the congressional debate on health reform.

But we are the only health-care reform movement with strong and growing grass-roots support, and we will be heard.

JAMES FLOYD
Washington

The writer, a physician and a health researcher for Public Citizen, which supports single-payer national health insurance, attended the hearing in question.

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/14/AR2009061402388.html

By Philip Moeller
U.S. News and World Report
June 16, 2009

Health-care costs are the dominant cause of personal bankruptcies, according to a recent study based on detailed 2007 records and extensive interviews with people who filed for bankruptcy that year. The study was released for maximum impact amidst the Congressional debate over health-care reform, and it has been repeatedly cited as proof that the system needs fixing. While that may be a valuable outcome of the research, its underlying message will not be altered any time soon by reform efforts: health-care expenses are the largest uncontrollable expense that Americans face, and insurance does not make the problem go away. For seniors and those nearing traditional retirement age, setting aside funds for future health-care expenses simply must assume greater importance in financial plans.

More than 62 percent of personal bankruptcies in 2007 were related to medical expenses — up nearly 50 percent from 2001 — according to “Medical Bankruptcy in the United States, 2007.” Its authors, academics David U. Himmelstein, Deborah Thorne, Elizabeth Warren, and Steffie Woolhandler, said their work represented the first-ever national random survey of bankruptcy filers. The results were summarized in the American Journal of Medicine.

“Most medical debtors were well educated, owned homes, and had middle-class occupations,” the authors said, adding that nearly 80 percent of 2007 medical bankruptcies involved people who had health insurance at the time their medical problems began (60.3 percent with private insurance as their primary coverage, 10.2 percent with Medicare, 5.4 percent with Medicaid, and 2 percent with Veterans Affairs coverage).

Tougher bankruptcy rules were enacted several years ago; filings peaked in 2005 and then declined, the authors said. “Since then, filings have increased each quarter. They are likely to exceed one million households in 2008, representing about 2.7 million people.” According to Automated Access to Court Electronic Records, which tracks bankruptcies, personal filings have soared past the 6,000 per-day rate and may total 1.5 million this year.

In addition to being under-insured when their medical problems began, the 2007 study found that many people with private insurance coverage lost it after becoming ill. “Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year,” the study said.

In planning for future medical expenses, the study said:

“Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families: $26,971 for uninsured patients, $17,749 for those with private insurance at the outset, $14,633 for those with Medicaid, $12,021 for those with Medicare, and $6,545 for those with Veterans Affairs/military coverage. For patients who initially had private coverage but lost it, the family’s out-of-pocket expenses averaged $22,568.”

Hospital costs were the largest out-of-pocket expense for nearly half of the people filing for bankruptcy, followed by prescription drugs (19 percent), doctor’s bills (15 percent), and premiums (4 percent). Drugs were the major expense for patients with pulmonary, cardiac, or psychiatric illnesses. For a group of the most common medical conditions, the study found the highest out-of-pocket expenses were for non-stroke neurological illnesses such as multiple sclerosis ($34,167, expressed as a mean of expenses), followed by diabetes ($26,971), injuries ($25,096), stroke ($23,380), mental illnesses ($23,178), and heart disease ($21,955).