Click here for a flyer for the rally.
America’s Health Insurance Plans (AHIP) Annual Conference
Where: San Diego Convention Center
When: Thursday, June 4
Time: 8:00 am — 10:30 am
Please come out for this rally to show your support for SB 810 & HR 676
Click here for a flyer for the rally.
America’s Health Insurance Plans (AHIP) Annual Conference
Where: San Diego Convention Center
When: Thursday, June 4
Time: 8:00 am — 10:30 am
Please come out for this rally to show your support for SB 810 & HR 676
By MICHAEL MOORE
The Missoulian
May 26, 2009
Steve McArthur is a management consultant.
Read self-employed.
That means he has to buy his own insurance, a Blue Cross Blue Shield policy that costs him $584 a month and carries a $10,000 deductible.
On Tuesday morning, he listened for a long time as Missoulians discussed health care reform at a listening session at St. Patrick Hospital sponsored by U.S. Sen. Max Baucus, D-Mont.
The hearing ranged broadly over the possibilities for reform, but what clearly resonated for McArthur was something Baucus’ chief of staff, Jon Selib, said a couple of times.
Discussing why a single-payer system of health insurance wasn’t viable, Selib made reference to the more than 150 million Americans who are covered by some sort of employer-provided health care.
“A lot of people like that,” Selib said.
When the time came for questions, McArthur stood up and asked a simple question. Looking across a standing-room-only crowd of about 275, he asked how many were happy with their employer-based health insurance.
Less than 10 people raised their hands.
“The number is bogus,” McArthur said. “It’s not working for 95 percent of us.”
McArthur drew resounding applause.
In fact, any mention of single-payer health care insurance brought raucous cheers and clapping. Any other solution to health care reform – including Baucus’ “balanced” plan that would create a mix of public and private plans – was received more coolly.
Tuesday’s session was one of a handful of events Baucus is sponsoring around the state this week. He chairs the Senate’s powerful Finance Committee, and is the point man on health care reform.
He did not attend Tuesday’s meeting, but Selib did, and he heard what the senator himself has heard since he announced that single-payer wasn’t really on the table.
As Selib worked to massage that point, one man barked out, “Oh bull—-.” Tom Roberts, president of the Western Montana Clinic and moderator at the session, asked the crowd to be civil, but the man had made his point.
The session included a panel of speakers, then a round of questions.
The panel made a variety of references to how health care would be paid for, but also made it clear that insurance isn’t the only problem with the American health care system.
Much was made about how much Americans spend on health care – more than $7,000 a year – and how little we get for it. Our health care system ranks 37th worldwide.
What we need, the director of the Missoula City-County Health Department said, is more focus on preventative health care over acute care.
“It’s not just about health care,” said Ellen Leahy. “I want health.”
Jeff Fee, president and chief executive officer of St. Patrick Hospital, said the current economic model of successful hospitals is precisely inverse to what we want in our communities.
A hospital does best, Fee said, when its beds are full.
“We need to turn that upside down,” said Fee, who noted that a healthy community wouldn’t fill its hospitals’ beds.
That sentiment, too, drew loud applause.
The clear message from Tuesday’s meeting is that Missoulians have high standards for health care reform. They want to be heard as clearly as are executives from the insurance companies and HMOs.
“I’ve been traveling all over to the discussions, and we’ve just got to make it clear that we need coverage for everyone,” said Bob Putsch, an emeritus professor at the University of Washington School of Medicine. “They need to listen to us.”
Reporter Michael Moore can be reached at 523-5252 or at mmoore@missoulian.com.
By EMILY DONOHUE
The Saratogian
Tuesday, May 26, 2009
FULTON COUNTY — While Beverly Alves’ husband, Joseph, battled pancreatic cancer in 2006, she battled a medical establishment that she says was ill-equipped to handle the coordination of care her husband needed.
“It should’ve been a ballet; instead it was a whole bunch of great ballroom dancers,” she said. It didn’t have to be that way, she maintains. Her husband’s medical situation was complex and his disease almost certainly fatal, but palliative care — which aims to coordinate specialists, nurses, social workers and other health care professionals in order to best care for patients — would have made his last months more manageable.
On an individual basis, the doctors and nurses who treated her husband did a good job, Alves said. They failed, however, to communicate with each other and coordinate the complex care Joseph required in the waning months and days of his life.
Alves, along with Dr. George Jolly, a Saratoga Springs internist and geriatrician, is hoping to raise awareness and support for a single-payer health care system. That type of system, she said, would include the palliative care that could have eliminated the lack of synchronization she and her husband dealt with during his illness.
“I had to plead and beg for him to get necessary tests and procedures,” Alves said. After a gastroenterologist determined there was a mass on Joseph’s pancreas, the doctor ordered a biopsy of both his pancreas and his liver to make a diagnosis.
It took three weeks of daily phone calls to a local hospital, Alves said, before her husband was seen, but for some reason that hospital only performed the biopsy on his pancreas. When the Alveses took the results to an oncologist, he said there was nothing he could do until Joseph had the liver biopsy.
It took two more weeks of phone calls before Alves was able to get her increasingly sick husband into the hospital for that biopsy. Finally, five weeks after the initial tests were ordered, an oncologist was able to give the Alveses the devastating diagnosis of pancreatic cancer.
Getting the diagnosis, Alves said, was only the beginning of months of failed communication and conflicting advice from the bevy of doctors, nurses and specialists her husband saw at several hospitals in the area.
Their situation was complicated, she added, by the fact that they lived in Ephratah, a small town in rural Fulton County. The local hospital is small and was not equipped to handle the complex care Joseph required. Alves was forced to transport him to doctors’ offices and hospitals in Schenectady and Albany, driving upwards of an hour each way. Their doctors, Alves said, never seemed to make the connection that she was trying to care for her husband on her own in a rural community. One doctor gave prescriptions that required her to travel to a faraway pharmacy every 48 hours. Another suggested a treatment to Joseph that would have required Alves to transport her then-paralyzed husband to and from Albany every day without seeming to realize the impossible burden that placed on her.
In the final days of her husband’s life, as she sat by his bedside in an Albany hospital, the lack of communication between doctors was particularly acute, Alves said.
His living will was misplaced by hospital staff, so Alves again got verbal confirmation from her husband that he did not want to be resuscitated should the need arise. She communicated this to his doctors, she said. Despite that, in the middle of the night, doctors woke Joseph up to ask him if he wanted to be resuscitated.
“The care, because of the lack of coordination, was atrocious,” she said.
In those final days, different doctors at the same hospital alternately told Alves that she should take her husband home because there was nothing that could be done and he was taking up a needed bed, that he was too critical to be moved and needed to stay, and that he should be in Hospice care. Never, she said, did anyone offer to help her make a decision or work out the complicated details.
“The last few months and days of a person’s life are the most important and should be treated with compassion,” she said.
Her husband died Dec. 18, 2006. “I accept the fact that there was nothing they could do to save my husband’s life … what troubles me is they could’ve made his last days better,” Alves said.
Since struggling to coordinate care for her husband, Alves has become involved in a local chapter of Single Payer NY, a movement advocating for a bill, HR-676, that has been introduced by Rep. John Conyers Jr., D-Mich. That bill, introduced every year since 2003, aims to create a publicly financed, privately delivered nationwide health care program. Advocates say the system would eliminate the layers of paperwork-generating bureaucracy that currently plague health care and drive up costs. Essentially, the bill creates a Medicare system for everyone, not just people over 65.
If palliative care had been available for her husband, “there would’ve been a team,” Alves said.
“They would have been following him, not just the floor.”
That kind of coordination is made nearly impossible, Dr. Jolly said, in the country’s current fragmented health insurance system. “In our current system … with all different kinds of payment, it becomes very hard to coordinate,” he said.
“A fragmented system is poisonous for the patient and the family,” he added.
Both Alves and Jolly said they are dismayed that a single-payer plan does not seem to be on the table in President Obama’s health care reform discussions. In the plans, he is advocating “all the old flaws of the present system be maintained,” Jolly said.
“We’re not espousing a political philosophy, really — what we’re saying is we’re all in this together … any one of us can get sick at any moment and lose our insurance,” Jolly said. “We don’t have to allow ourselves to remain vulnerable.”
Conyers’ single-payer bill has many components, but its palliative care aspect is of particular import to Alves. She called his office to urge him to add palliative care to the bill and in early January received word that it had been added to the 2009 version.
HR-676 currently has 77 co-signers in Congress. On April 21, the Saratoga Springs City Council voted 4-1 to pass a resolution supporting the bill.
By David Lazarus
Los Angeles Times
May 27, 2009
San Marcos resident Maggie Yount wasn’t surprised when the letter from insurance giant Anthem Blue Cross arrived the other day. Yet she couldn’t help but be frustrated.
“Some medical conditions, either alone or in combination with the cost of medication, present uncertain medical underwriting risks,” Anthem informed her. “In view of these risks, we find we are unable to offer you enrollment at this time.”
In other words, no health coverage for you.
Yount, 24, finds herself in that cloudy area in which a “preexisting condition” makes her too great a risk in the eyes of money-minded insurance companies. And so she’s being excluded from the system.
“It looks like I’ll just have to be very, very careful about everything,” Yount told me. “But what kind of way is that to live your life?”
If that were all there was to it, her story would still be worth telling as the Obama administration embarks on an ambitious effort to reform the woefully dysfunctional U.S. healthcare system.
But Yount’s tale runs even deeper.
In November 2007, she was rushed to the emergency room after a drunk driver crashed into her car on a Nova Scotia highway.
Yount awoke from a coma four days later. She had suffered a brain injury in the head-on collision. Thirteen bones were broken, from her leg to her cheek. The other driver was killed.
Yount, a Canadian citizen, spent three months in a Halifax hospital, receiving treatment and rehab that must have cost a small fortune.
“I have no idea how much it cost,” she said. “It’s not something I’ve ever needed to know.”
So who paid the bill?
“The government of Canada.”
The United States is the only industrialized democracy that doesn’t have a government-run insurance system. Under such systems, universal coverage is provided through tax revenue. There are no premiums, co-pays or deductibles.
It’s not a perfect system — people often end up waiting for nonessential treatment. But it won’t leave you destitute if things go bad. Basically, you’re covered. For everything.
In Yount’s case, that ended when she moved to San Marcos in northern San Diego County a year ago to be with her fiance. They were married last July.
She then tried to obtain health coverage under the U.S. system. Her American husband works as a software engineer on a contract basis and doesn’t have employer-provided coverage.
Before applying to Anthem, Yount applied for an individual policy offered by Aetna Inc. She received a letter a couple of months ago informing her that her application had been rejected.
The letter noted that Yount’s medical record includes “a history of traumatic brain injury with multiple fractures treated with hospitalization.” It concluded that “this condition exceeds the allowable limits provided by our underwriting guidelines.”
That’s a fancy way of saying there’s a pretty good chance Yount will require medical care of one sort or another in the future. This would be bad for Aetna’s business.
“If anybody from Aetna had actually spoken to me, they’d see I’m not mentally challenged because of the brain injury,” Yount said. “I still have some issues related to it, such as short-term memory loss, but I no longer have the need for acute medical care.”
As for all those broken bones: “They’ve healed,” Yount said. “That’s over. What, are they going to deny people coverage because they once had a broken arm?”
Anjanette Coplin, an Aetna spokeswoman, was unable to discuss Yount’s case. But she said the company considers a variety of factors before rejecting an applicant for coverage. These can include a person’s overall condition, medical history and prospects for ongoing treatment.
“We feel that our underwriting guidelines give the greatest number of consumers the opportunity to purchase affordable, quality health insurance products,” Coplin said.
Yount’s response: Companies like Aetna and Anthem are denying coverage based solely on history rather than a reasonable expectation of what could happen down the road.
“I want insurance for what could happen in the future — just in case,” she said. “That’s what insurance is for. But I can’t get it.”
I don’t blame Aetna or Anthem. If you offer health insurance as a for-profit business, it goes without saying that you’ll do everything you can to avoid making payouts. That means you’ll shun anyone with even a whiff of medical trouble.
But this is no way to run an insurance system, let alone to protect people from financial ruin due to catastrophic events such as being sent to the hospital by a drunk driver.
The Obama administration has already rejected the idea of a single-payer system similar to Canada’s — a mistake, in my opinion. Instead, it wants a smaller public program that would compete with private insurers and keep costs down.
Private insurers, not surprisingly, are lobbying aggressively to kill off that idea. They’d rather have a national mandate that would require all Americans to buy their product.
In return, they say, they’d stop sending rejection letters to people like Yount with preexisting conditions. But policyholders would still be subject to the companies’ various terms and conditions.
Maybe one compromise would be to let private insurers handle the small stuff and to have a public program that could tackle the catastrophic stuff.
I asked Yount what would have happened if she’d gotten into her accident in Southern California instead of Nova Scotia.
“I can’t say whether my care would have been better or worse,” she replied. “But I know this: I’d be bankrupt now.”
“I’m not a religious person,” Yount added. “But I thank God my accident happened where it did.”
David Lazarus’ column runs Wednesdays and Sundays. Send your tips or feedback to david.lazarus@latimes.com.
http://www.latimes.com/business/la-fi-lazarus27-2009may27,0,2252325.column
PRESS RELEASE
For Immediate Release
Tuesday, May 26, 2009
Contact:
Cathy Albisa on 212-253-1710 x 303 or cathy@nesri.org
Victoria Grant on 212-253-1710 x 308 or victoria@nesri.org
At a critical moment for health care reform in the United States, The National Economic & Social Rights Initiative has published an in-depth assessment of single payer proposals, finding that a single payer system goes further towards meeting key human rights principles than market-based plans.
The question of whether national leaders will consider a single payer system as an option for health care reform has become a question of basic democracy. Despite most Americans supporting a single payer solution, the Obama Administration and congressional leaders have denied it consideration. Key stakeholders such as health care professionals, patients and single payer advocates have been excluded from hearings regarding health reform, prompting courageous civil disobedience actions by health care advocates. One of the protesters at the recent Senate Finance Hearings, Dr Margaret Flowers of PNHP Maryland, said: “We have entered a new phase in the movement for health care as a human right: acts of civil disobedience. It is time to directly challenge corporate interests. History has shown that in order to gain human rights, we must be willing to speak out and risk arrest”.
In a recent article, Donna Smith of the California Nurses Association critically suggests that any health care reform bill that comes out of Washington will be falsely advertised as a “human rights victory”. But what would a true human rights victory look like? NESRI’s report addresses that question.
The report analyzes four bills (Conyers HR676, Sanders S703/McDermott HR1200, Vermont S99/H100 and Minnesota SF118/HF135) against key human rights principles such as universality, equity, affordability and comprehensiveness. It shows that if health care reformers are serious about achieving a system that respects human rights, single payer proposals must be given consideration as they would vastly increase access to quality care for all individuals and secure long-term financial sustainability.
NESRI’s report is intended to support the efforts of human right to health care advocates by providing a serious analysis of the benefits of a single payer plan. Cathy Albisa, co-founder of NESRI, said: “We have a fundamental choice to make as a country; we can either be guided by human rights that reflect our founding values or we can continue down the path of special corporate interests. The kind of health care system our government puts in place and what weight is given to the opinion of the American people in the upcoming debate is an important barometer of the health of our democracy and our ability to move towards a more equitable society.”
“A Human Rights Assessment of Single Payer Plans” is available for download at www.nesri.org.
###
NESRI – 90 John Street, Suite 308 – New York, NY 10038 – Ph: 212.253.1710 – info@nesri.org
Editorial
Indianapolis Star
May 25, 2009
Indiana Sen. Evan Bayh’s vote could prove critical as Congress debates health-care reform later this year. Yet, Bayh has a clear personal interest in the financial stability of one of the key players in that debate — Indianapolis-based WellPoint, the nation’s largest commercial health insurer.
Bayh’s ties to WellPoint could hardly be more direct for a sitting senator. His wife, Susan, as a member of the company’s board of directors, earned compensation valued at $327,000 from WellPoint last year.
Both the senator and the insurance company deny that there’s a conflict of interest caused by Susan Bayh’s work as a director. A spokesman for the senator said that WellPoint is prohibited from communicating with Bayh’s office. Nor does Susan Bayh, according to the spokesman, discuss issues affecting WellPoint with her husband or his staff.
But WellPoint’s future — and thus a significant portion of the Bayhs’ income — could be at risk as the Obama administration and Congress attempt to reshape the nation’s health-care system.
In a meeting with The Star Editorial Board last week, WellPoint CEO Angela Braly noted that one potential approach — a government-run plan — could cover the health-care needs of as many as 130 million Americans within a year of implementation. Such a move would dramatically undermine WellPoint and other commercial insurers’ business model.
As Braly and many others have pointed out, there’s much to be wary of in having the federal government try to meet Americans’ health insurance needs. The federal government doesn’t exactly have the best track record in controlling costs or rooting out fraud and waste in a broad range of its programs. The thought of dismantling a private-sector industry to further expand government’s role also should give Congress serious pause.
Those are points that Evan Bayh, as a leading Senate moderate, can and should make. But the strength of his message is sure to be undercut by suspicions raised over his wife’s ties to WellPoint.
Even if one accepts the Bayhs’ and WellPoint’s assurances that safeguards are in place — and there’s no evidence that anything legally or ethically improper has ever occurred — the close relationship between the senator’s wife and the insurer is an obvious conflict of interest. And it’s one that by default limits the senator’s ability to lead on an issue of critical importance to the nation and state.
By David Lazarus
Los Angeles Times
May 27, 2009
San Marcos resident Maggie Yount wasn’t surprised when the letter from insurance giant Anthem Blue Cross arrived the other day. Yet she couldn’t help but be frustrated.
“Some medical conditions, either alone or in combination with the cost of medication, present uncertain medical underwriting risks,” Anthem informed her. “In view of these risks, we find we are unable to offer you enrollment at this time.”
In other words, no health coverage for you.
Yount, 24, finds herself in that cloudy area in which a “preexisting condition” makes her too great a risk in the eyes of money-minded insurance companies. And so she’s being excluded from the system.
“It looks like I’ll just have to be very, very careful about everything,” Yount told me. “But what kind of way is that to live your life?”
If that were all there was to it, her story would still be worth telling as the Obama administration embarks on an ambitious effort to reform the woefully dysfunctional U.S. healthcare system.
But Yount’s tale runs even deeper.
In November 2007, she was rushed to the emergency room after a drunk driver crashed into her car on a Nova Scotia highway.
Yount awoke from a coma four days later. She had suffered a brain injury in the head-on collision. Thirteen bones were broken, from her leg to her cheek. The other driver was killed.
Yount, a Canadian citizen, spent three months in a Halifax hospital, receiving treatment and rehab that must have cost a small fortune.
“I have no idea how much it cost,” she said. “It’s not something I’ve ever needed to know.”
So who paid the bill?
“The government of Canada.”
The United States is the only industrialized democracy that doesn’t have a government-run insurance system. Under such systems, universal coverage is provided through tax revenue. There are no premiums, co-pays or deductibles.
It’s not a perfect system — people often end up waiting for nonessential treatment. But it won’t leave you destitute if things go bad. Basically, you’re covered. For everything.
In Yount’s case, that ended when she moved to San Marcos in northern San Diego County a year ago to be with her fiance. They were married last July.
She then tried to obtain health coverage under the U.S. system. Her American husband works as a software engineer on a contract basis and doesn’t have employer-provided coverage.
Before applying to Anthem, Yount applied for an individual policy offered by Aetna Inc. She received a letter a couple of months ago informing her that her application had been rejected.
The letter noted that Yount’s medical record includes “a history of traumatic brain injury with multiple fractures treated with hospitalization.” It concluded that “this condition exceeds the allowable limits provided by our underwriting guidelines.”
That’s a fancy way of saying there’s a pretty good chance Yount will require medical care of one sort or another in the future. This would be bad for Aetna’s business.
“If anybody from Aetna had actually spoken to me, they’d see I’m not mentally challenged because of the brain injury,” Yount said. “I still have some issues related to it, such as short-term memory loss, but I no longer have the need for acute medical care.”
As for all those broken bones: “They’ve healed,” Yount said. “That’s over. What, are they going to deny people coverage because they once had a broken arm?”
Anjanette Coplin, an Aetna spokeswoman, was unable to discuss Yount’s case. But she said the company considers a variety of factors before rejecting an applicant for coverage. These can include a person’s overall condition, medical history and prospects for ongoing treatment.
“We feel that our underwriting guidelines give the greatest number of consumers the opportunity to purchase affordable, quality health insurance products,” Coplin said.
Yount’s response: Companies like Aetna and Anthem are denying coverage based solely on history rather than a reasonable expectation of what could happen down the road.
“I want insurance for what could happen in the future — just in case,” she said. “That’s what insurance is for. But I can’t get it.”
I don’t blame Aetna or Anthem. If you offer health insurance as a for-profit business, it goes without saying that you’ll do everything you can to avoid making payouts. That means you’ll shun anyone with even a whiff of medical trouble.
But this is no way to run an insurance system, let alone to protect people from financial ruin due to catastrophic events such as being sent to the hospital by a drunk driver.
The Obama administration has already rejected the idea of a single-payer system similar to Canada’s — a mistake, in my opinion. Instead, it wants a smaller public program that would compete with private insurers and keep costs down.
Private insurers, not surprisingly, are lobbying aggressively to kill off that idea. They’d rather have a national mandate that would require all Americans to buy their product.
In return, they say, they’d stop sending rejection letters to people like Yount with preexisting conditions. But policyholders would still be subject to the companies’ various terms and conditions.
Maybe one compromise would be to let private insurers handle the small stuff and to have a public program that could tackle the catastrophic stuff.
I asked Yount what would have happened if she’d gotten into her accident in Southern California instead of Nova Scotia.
“I can’t say whether my care would have been better or worse,” she replied. “But I know this: I’d be bankrupt now.”
“I’m not a religious person,” Yount added. “But I thank God my accident happened where it did.”
David Lazarus’ column runs Wednesdays and Sundays. Send your tips or feedback to david.lazarus@latimes.com.
http://www.latimes.com/business/la-fi-lazarus27-2009may27,0,2252325.column
From Healthcare-NOW!
http://www.healthcare-now.org/campaigns/may-30th-day-of-action/
Nationwide Rallies for Improved Medicare for All
Join thousands of single-payer supporters in a nationwide week of action to support improved Medicare for all (HR 676). Single-payer activists will be gathering all over the country to say, “Healthcare, yes; Insurance companies, no,” and to show solidarity with demonstrations at the AHIP (American Health Insurance Plans, a private health insurance lobby) conference in San Diego.
If an action isn’t already in your city, plan your own day of action! It can be a town hall meeting, demonstration in front of a local insurance company, film showing, vigil, or your own unique idea. Let us know what you’d like to start planning by contacting info@healthcare-now.org.
47 million Americans are uninsured. Private insurance rates are rising faster than inflation and our incomes. By 2025 the cost of private health insurance will exceed our projected income.
More Small Firms Drop Health Care
By Dana Mattioli
The Wall Street Journal
May 26, 2009
Accelerating health-care premiums and sharp revenue shortfalls due to the recession are forcing some small companies to choose between dropping health insurance or laying off workers — or staying in business at all.
About 10% of small businesses are considering eliminating coverage over the next year, up from 3% in 2005, according to a recent survey by National Small Business Association.
That follows earlier declines in coverage, with just 38% of small businesses providing health insurance last year compared to 61% in 1993, according to the trade group. A Hewitt Associates survey found that 19% of all companies plan to stop providing health-care benefits in the next three to five years.
http://online.wsj.com/article/SB124329442612051953.html
Rampant health care cost escalation is a problem for everyone. In bad economic times the problems are compounded, threatening the viability of employer-sponsored coverage. Small businesses that operate on very narrow margins have no choice but to reduce health benefits by either shifting more of the health care costs to their employees, or by eliminating health plans altogether. The fault lies not with the small business owners, but with the flawed U.S. system of financing health care.
The recent Medicare trustees report indicates that Medicare is facing similar economic challenges. But there is a very crucial difference. Everyone recognizes that the high costs of Medicare reflect the excessive rate of increases in total health care spending, and that runaway costs must be harnessed. The stewards of Medicare would never consider reducing legitimate health care benefits, or worse, eliminating many Medicare beneficiaries from coverage.
The point is that the structure of the financing system really matters. We can have a system in which individuals or employers are forced by economic circumstances to reduce or eliminate the financing of essential health care services, or we can have a system in which the government is forced by economic circumstances to demand greater efficiency by the health care delivery system so that everyone can have the health care that they need.
Unfortunately, members of Congress are moving forward with a model that will leave individuals and employers financially vulnerable for our health care needs – a patchwork of private plans and public programs that grow ever less affordable for most of us.
The model that would work is a single payer national health program. But last week, after a recital of several options that are still on the table, Sen. Baucus finally admitted, “Just to be honest, (single payer) is not on the table because it cannot pass.”
Hmmm… bad policies can pass but good policies can’t? Is there something wrong with the way Congress operates?
By Dana Mattioli
The Wall Street Journal
May 26, 2009
Accelerating health-care premiums and sharp revenue shortfalls due to the recession are forcing some small companies to choose between dropping health insurance or laying off workers — or staying in business at all.
About 10% of small businesses are considering eliminating coverage over the next year, up from 3% in 2005, according to a recent survey by National Small Business Association.
That follows earlier declines in coverage, with just 38% of small businesses providing health insurance last year compared to 61% in 1993, according to the trade group. A Hewitt Associates survey found that 19% of all companies plan to stop providing health-care benefits in the next three to five years.
http://online.wsj.com/article/SB124329442612051953.html
By Don McCanne, MD
Rampant health care cost escalation is a problem for everyone. In bad economic times the problems are compounded, threatening the viability of employer-sponsored coverage. Small businesses that operate on very narrow margins have no choice but to reduce health benefits by either shifting more of the health care costs to their employees, or by eliminating health plans altogether. The fault lies not with the small business owners, but with the flawed U.S. system of financing health care.
The recent Medicare trustees report indicates that Medicare is facing similar economic challenges. But there is a very crucial difference. Everyone recognizes that the high costs of Medicare reflect the excessive rate of increases in total health care spending, and that runaway costs must be harnessed. The stewards of Medicare would never consider reducing legitimate health care benefits, or worse, eliminating many Medicare beneficiaries from coverage.
The point is that the structure of the financing system really matters. We can have a system in which individuals or employers are forced by economic circumstances to reduce or eliminate the financing of essential health care services, or we can have a system in which the government is forced by economic circumstances to demand greater efficiency by the health care delivery system so that everyone can have the health care that they need.
Unfortunately, members of Congress are moving forward with a model that will leave individuals and employers financially vulnerable for our health care needs – a patchwork of private plans and public programs that grow ever less affordable for most of us.
The model that would work is a single payer national health program. But last week, after a recital of several options that are still on the table, Sen. Baucus finally admitted, “Just to be honest, (single payer) is not on the table because it cannot pass.”
Hmmm… bad policies can pass but good policies can’t? Is there something wrong with the way Congress operates?
By Dr. Marcia Angell
Boston Globe
May 23, 2009
The Senate Finance Committee’s hearings on health reform earlier this month did not include testimony from any advocate for single-payer insurance. Physicians for a National Health Program, which represents 16,000 doctors, asked the committee to invite me to testify, but it chose not to. If I had been invited, this is what I would have said:
The reason our health system is in such trouble is that it is set up to generate profits, not to provide care. We rely on hundreds of investor-owned insurance companies that profit by refusing coverage to high-risk patients and limiting services to others. They also cream off about 20 percent of the premiums for profits and overhead.
In addition, we provide much of our medical care in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most physicians are paid fee-for-service, which gives them a similar incentive, particularly specialists who receive very high fees for performing expensive tests and procedures. Nonprofits behave much like for-profits, because they must compete with them. In sum, healthcare is directed toward maximizing income, not maximizing health. In economic terms, it’s a highly successful industry, but it’s a massive drain on the rest of the economy.
The reform proposals advocated by President Obama are meant to increase coverage for the uninsured. That is certainly a worthwhile goal, but the problem is that they leave the present profit-driven and highly inflationary system essentially unchanged, and simply pour more money into it – an unsustainable situation. That is what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are poor without cutting benefits and greatly increasing co-payments. Initiatives such as electronic records, case management, preventive care, and comparative effectiveness studies may improve care, but the Congressional Budget Office and most health economists agree that they are unlikely to save much money. Promises by for-profit insurers and providers to mend their ways voluntarily are not credible.
Nearly every other advanced country has a largely nonprofit national health system that provides universal and comprehensive care. Expenditures are on average about half as much per person, and health outcomes are generally much better. Moreover, these countries offer more basic services, not fewer. They have on average more doctors and nurses, more hospital beds, longer hospital stays, and there are more doctor visits. But they don’t do nearly as many tests and procedures, because there is little financial incentive to do so.
It is often argued that the first order of business should be to expand coverage, and then worry about costs later. But it is essential to deal with both together to stop the drain on the rest of the economy and the further fraying of healthcare. The only way to provide universal and comprehensive coverage and control costs is to adopt a nonprofit single-payer system. Medicare is a single-payer system, with low overhead costs, but it uses the same profit-oriented providers as the private system and also preferentially rewards specialists for tests and procedures. Consequently, its costs are rising almost as rapidly as those in the private sector. Representative John Conyers introduced an excellent bill that calls for extending Medicare to everyone in a nonprofit delivery system. That could be done gradually, by lowering the Medicare age a decade at a time.
A single-payer system is ignored by lawmakers because of the influence of the health industry lobbies. They raise the specter of rationing and long waits for care. There are indeed waits for some elective procedures in some countries with national health systems, such as the United Kingdom. But that’s because they spend far less on healthcare than we do. For them, the problem is not the system; it’s inadequate funding. For us, it’s not the funding; it’s the system. We spend more than enough.
I urge you to consider a nonprofit single-payer system. The economic interests of the health industry should not be permitted to hold the rest of the economy hostage and threaten the health and well-being of the public.
Dr. Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine.