PNHP

The uninsured give but rarely receive transplants

The uninsured give but rarely receive transplants

Insurance Status of U.S. Organ Donors and Transplant Recipients: The Uninsured Give, but Rarely Receive

By Andrew A. Herring, Steffie Woolhandler, and David U. Himmelstein
International Journal of Health Services
Volume 38, Number 4
In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy. The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors.
Abstract
Organ transplantation is an expensive, life-saving technology. Previous studies have found that few transplant recipients in the United States lack health insurance (in part because patients may become eligible for special coverage because of their disability and transplant teams vigorously advocate for their patients). Few data are available on the insurance status of U.S. organ donors. The authors analyzed the 2003 National Inpatient Sample (NIS), a nationally representative 20 percent sample of U.S. hospital stays, and identified incident organ donors and recipients using ICD-9-CM diagnosis and procedure codes. The NIS sample included 1,447 organ donors and 4,962 transplant recipients, equivalent after weighting to 6,517 donors and 23,656 recipients nationwide; 16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured. In multivariate analysis, compared with other inpatients organ donors were much more likely to be uninsured (OR 3.41, 95% CI 2.81-4.15), whereas transplant recipients were less likely to lack coverage (OR 0.08, 95% CI 0.06-0.12). Many uninsured Americans donate organs, but they rarely receive them.
https://pnhp.org/organ_donors/Transplants.pdf

Because of the mismatch between the numbers of individuals who are candidates to receive organ transplants and the numbers of donors available, sometimes difficult decisions have to be made as to who will receive the transplants. As complex as these decisions are, it is a sad commentary that, in the United States, we add one additional complicating factor: Does the potential recipient have insurance?
It is reassuring to note that the dedicated transplant teams can sometimes break through this barrier through vigorous advocacy on behalf of their patients. But it is wrong that they should have to do that. And it is especially wrong that uninsured candidates may be unsuccessful in negotiating this barrier.
These life and death decisions are not based on a lack of money; we are already spending more than enough. Rather people are dying merely because of the way we allocate that money. A single payer national health program would remove money as a consideration and allow us to concentrate on the other moral and ethical factors that should determine who lives and who dies.
What a terrible decision to have to make. But let’s not make it based on ability to pay.

The uninsured give but rarely receive transplants

Insurance Status of U.S. Organ Donors and Transplant Recipients: The Uninsured Give, but Rarely Receive

By Andrew A. Herring, Steffie Woolhandler, and David U. Himmelstein
International Journal of Health Services
Volume 38, Number 4

In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy. The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors.

Abstract

Organ transplantation is an expensive, life-saving technology. Previous studies have found that few transplant recipients in the United States lack health insurance (in part because patients may become eligible for special coverage because of their disability and transplant teams vigorously advocate for their patients). Few data are available on the insurance status of U.S. organ donors. The authors analyzed the 2003 National Inpatient Sample (NIS), a nationally representative 20 percent sample of U.S. hospital stays, and identified incident organ donors and recipients using ICD-9-CM diagnosis and procedure codes. The NIS sample included 1,447 organ donors and 4,962 transplant recipients, equivalent after weighting to 6,517 donors and 23,656 recipients nationwide; 16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured. In multivariate analysis, compared with other inpatients organ donors were much more likely to be uninsured (OR 3.41, 95% CI 2.81-4.15), whereas transplant recipients were less likely to lack coverage (OR 0.08, 95% CI 0.06-0.12). Many uninsured Americans donate organs, but they rarely receive them.

https://pnhp.org/organ_donors/Transplants.pdf

Comment:

By Don McCanne, MD

Because of the mismatch between the numbers of individuals who are candidates to receive organ transplants and the numbers of donors available, sometimes difficult decisions have to be made as to who will receive the transplants. As complex as these decisions are, it is a sad commentary that, in the United States, we add one additional complicating factor: Does the potential recipient have insurance?

It is reassuring to note that the dedicated transplant teams can sometimes break through this barrier through vigorous advocacy on behalf of their patients. But it is wrong that they should have to do that. And it is especially wrong that uninsured candidates may be unsuccessful in negotiating this barrier.

These life and death decisions are not based on a lack of money; we are already spending more than enough. Rather people are dying merely because of the way we allocate that money. A single payer national health program would remove money as a consideration and allow us to concentrate on the other moral and ethical factors that should determine who lives and who dies.

What a terrible decision to have to make. But let’s not make it based on ability to pay.

Uninsured Give but Rarely Receive Organs for Transplant

Posted by Vanessa Fuhrmans
Wall Street Journal Blog
November 18, 2008, 8:26 am

Call it the ultimate inequity in health care. A team of Harvard researchers finds that people without health insurance are about 20 times more likely to donate a liver or kidney than to receive one.

The results of the study, which appear in the current issue of International Journal of Health Services, looked at U.S. transplant patients in 2003. It found that 16.9% of organ donors had no health insurance at the time of hospitalization. But only 0.8% of transplant recipients were uninsured.

Why the stark unfairness? The study’s authors say the share of uninsured donors is roughly proportionate to the total uninsured population. But donors also tend to be younger adults, who also happen to go without coverage at higher rates than older people.

The problem is on the recipient side. If someone doesn’t have financial resources or insurance, few medical centers will consider that patient a transplant candidate, the authors say.

The study was triggered after its lead author, Andrew Herring, then a third-year medical student, cared for a 25-year-old uninsured day laborer at Cambridge Hospital in Boston in 2005. Suffering from advanced cardiomyopathy, or a severely inflamed heart, the patient could not get on a transplant list, in part because he wouldn’t have been able to pay for the expensive medications needed to support his recovery. He later died.

“What struck us was he was eligible to give but not receive an organ,” says Steffie Woolhandler, the study’s co-author who was Herring’s supervisor at the time. “Had he been in a car accident six months before, everyone would have been willing to harvest his organs.” She says she doesn’t blame doctors, who must follow explicit criteria to put patients on transplant lists, but an inequitable system.

Senator urges reform to 'hodge-podge' health care system

By DIANE COCHRAN
The Billings Gazette Staff
10/20/2008

The nation’s health care system is broken, and Congress is obligated to repair it, Sen. Max Baucus told an audience in Billings on Monday.

“I think in life we only have two choices on most things – try, or do nothing, and clearly we’ve got to try to crack this nut,” Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. “Doing nothing is not an option.”

Reforming the country’s health care “hodge-podge” – it’s too fragmented to be called a system, Baucus said – will probably be the biggest problem he tackles in his Congressional career, the senator said.

“Maybe it’s a new definition of the term ‘masochism,’ but I have taken it on myself to address this challenge,” Baucus said.

The United States spends more on health care than does any other industrialized nation, but Americans are not healthier than people in other countries. In fact, we’re significantly less healthy.

And the costs associated with U.S. health care are rapidly rising.

In Montana, health insurance premiums increased at more than five times the rate of wages between 2000 and 2007, according to Baucus’ statistics.

Premiums rose almost 90 percent in that time, he said.

Everything should be on the table as lawmakers consider ways to improve health care, Baucus said.

That includes making health insurance a requirement for all Americans and implementing a single-payer system, although Baucus said he didn’t think the single-payer option was realistic.

Ted Cross, a retired small-business owner, told Baucus that health care needs to be simplified.

Cross said he was charged different amounts for two identical medical treatments at the same doctor’s office, and he couldn’t figure out why. When consumers can’t decipher their medical bills, they can’t tell if they’re being overcharged, he said.

“The complexity reminds me of derivatives in the mortgage industry, and we know what’s going on there,” Cross said.

Because it is complicated and disjointed, the health care system can be difficult for senior citizens to access, said Dr. Pat Coon, a gerontologist at Billings Clinic.

“There is a spectrum of services available to them, but the ability to attain them is often fragmented,” Coon said. “Rather than staying at home where they’d prefer to live, they’re forced to move into long-term care facilities.”

There are programs in place to help some people navigate the system, but not everyone qualifies for those programs, she said.

That means some people get better access than others, and physicians sometimes have to decide who gets it, Coon said.

Sue Bailey, program manager for the Yellowstone County Council on Aging Resource Center, urged Baucus to find a way to rein in skyrocketing medical costs.

If price increases continue to outpace inflation, even people who save for long-term care or future medical problems will have trouble paying their bills, Bailey said.

“Almost everyone, if they live long enough, is going to outlive their money,” she said.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.

Senator urges reform to ‘hodge-podge’ health care system

By DIANE COCHRAN
The Billings Gazette Staff
10/20/2008

The nation’s health care system is broken, and Congress is obligated to repair it, Sen. Max Baucus told an audience in Billings on Monday.

“I think in life we only have two choices on most things – try, or do nothing, and clearly we’ve got to try to crack this nut,” Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. “Doing nothing is not an option.”

Reforming the country’s health care “hodge-podge” – it’s too fragmented to be called a system, Baucus said – will probably be the biggest problem he tackles in his Congressional career, the senator said.

“Maybe it’s a new definition of the term ‘masochism,’ but I have taken it on myself to address this challenge,” Baucus said.

The United States spends more on health care than does any other industrialized nation, but Americans are not healthier than people in other countries. In fact, we’re significantly less healthy.

And the costs associated with U.S. health care are rapidly rising.

In Montana, health insurance premiums increased at more than five times the rate of wages between 2000 and 2007, according to Baucus’ statistics.

Premiums rose almost 90 percent in that time, he said.

Everything should be on the table as lawmakers consider ways to improve health care, Baucus said.

That includes making health insurance a requirement for all Americans and implementing a single-payer system, although Baucus said he didn’t think the single-payer option was realistic.

Ted Cross, a retired small-business owner, told Baucus that health care needs to be simplified.

Cross said he was charged different amounts for two identical medical treatments at the same doctor’s office, and he couldn’t figure out why. When consumers can’t decipher their medical bills, they can’t tell if they’re being overcharged, he said.

“The complexity reminds me of derivatives in the mortgage industry, and we know what’s going on there,” Cross said.

Because it is complicated and disjointed, the health care system can be difficult for senior citizens to access, said Dr. Pat Coon, a gerontologist at Billings Clinic.

“There is a spectrum of services available to them, but the ability to attain them is often fragmented,” Coon said. “Rather than staying at home where they’d prefer to live, they’re forced to move into long-term care facilities.”

There are programs in place to help some people navigate the system, but not everyone qualifies for those programs, she said.

That means some people get better access than others, and physicians sometimes have to decide who gets it, Coon said.

Sue Bailey, program manager for the Yellowstone County Council on Aging Resource Center, urged Baucus to find a way to rein in skyrocketing medical costs.

If price increases continue to outpace inflation, even people who save for long-term care or future medical problems will have trouble paying their bills, Bailey said.

“Almost everyone, if they live long enough, is going to outlive their money,” she said.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.

Aetna creates "Medical Home." Really?

Aetna and Partners in Care Test New Approach to Health Care Services

Aetna
News Release
November 13, 2008
New Model Creates a “Medical Home” for Patients that is Based on a Strong Primary Care Relationship and Close Coordination with Other Care Providers
Aetna (NYSE: AET) and Partners In Care, Corp. (PIC) today announced a pilot program to test an innovative new health care model that will make the health care system an easier place for patients. Called a “Patient-Centered Medical Home” the model emphasizes the role of the primary care physician (PCP) in managing and coordinating patient care across a range of care providers, including specialists and hospitals.
The Patient-Centered Medical Home concept of care has been under development since the mid-90s and is based on a patient having an ongoing relationship with a personal physician trained to provide first contact and continuous, comprehensive care. This personal physician leads a team of care providers at the practice level who collectively take responsibility for the ongoing care of patients, looking beyond the walls of their own office, and communicating with the patient’s other providers to assure the treatment plans are followed. The concept is designed to nurture and strengthen the relationship between the patient and physician.
“PIC sees its role as a physician organization as finding ways to support the practicing physicians in their effort to improve the overall quality of care provided to their patients, and by rewarding physicians for achieving national certification standards. This joint effort will have a significant impact,” said Kevin O’Brien, President & CEO, Partners In Care.
http://www.aetna.com/news/newsReleases/2008/1113_PICCorp.html

And…

Partners in Care, Corp.

Constituted as a for-profit, closely held, New Jersey corporation, the equity is held by seventy individual shareholders belonging to the United Medical Group (UMG).
Using the techniques developed under full-risk contract management, PIC has bundled patient health advocacy, managed care administration, and medical informatics into a series of customizable product and service lines. Our customer base includes individual physician practices, large physician organizations, mid-sized employers, health plans, and benefit consultants / brokers.
http://www.piccorp.com/aboutus.htm

Our very expensive but highly dysfunctional system of financing health care has resulted in serious deficiencies and neglect of the infrastructure of our health care delivery system. Foremost amongst these problems is the rapid deterioration of the primary care infrastructure.
It is not as if we have remained unaware of this very serious deficiency. In fact, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association have supported the medical home concept as a model for reinforcing primary care. The label is not important. What is important is the concept that everyone should have available a primary care entry point that improves access to coordinated, comprehensive health care services. This is not about gatekeepers. It’s about everyone receiving the health care that they need.
Our dysfunctional, fragmented, multi-payer and no payer system of financing health care has been incapable of realigning incentives and appropriately allocating resources to build and maintain the primary care structure that we need. We spend more money and we get less.
Don’t worry. Aetna, in partnership with Partners in Care, has usurped the “medical home” label to… provide us with a comprehensive primary care system? Well… No. On top of our flawed systems of financing and delivering care, they are adding “customizable product and service lines.” With our system already weighted down with an excess of egregiously wasteful administrative services, they are using the medical home label to sell us even more egregiously wasteful administrative services!

Aetna creates "Medical Home." Really?

Aetna and Partners in Care Test New Approach to Health Care Services

Aetna
News Release
November 13, 2008

New Model Creates a “Medical Home” for Patients that is Based on a Strong Primary Care Relationship and Close Coordination with Other Care Providers

Aetna (NYSE: AET) and Partners In Care, Corp. (PIC) today announced a pilot program to test an innovative new health care model that will make the health care system an easier place for patients. Called a “Patient-Centered Medical Home” the model emphasizes the role of the primary care physician (PCP) in managing and coordinating patient care across a range of care providers, including specialists and hospitals.

The Patient-Centered Medical Home concept of care has been under development since the mid-90s and is based on a patient having an ongoing relationship with a personal physician trained to provide first contact and continuous, comprehensive care. This personal physician leads a team of care providers at the practice level who collectively take responsibility for the ongoing care of patients, looking beyond the walls of their own office, and communicating with the patient’s other providers to assure the treatment plans are followed. The concept is designed to nurture and strengthen the relationship between the patient and physician.

“PIC sees its role as a physician organization as finding ways to support the practicing physicians in their effort to improve the overall quality of care provided to their patients, and by rewarding physicians for achieving national certification standards. This joint effort will have a significant impact,” said Kevin O’Brien, President & CEO, Partners In Care.

http://www.aetna.com/news/newsReleases/2008/1113_PICCorp.html

And…

Partners in Care, Corp.

Constituted as a for-profit, closely held, New Jersey corporation, the equity is held by seventy individual shareholders belonging to the United Medical Group (UMG).

Using the techniques developed under full-risk contract management, PIC has bundled patient health advocacy, managed care administration, and medical informatics into a series of customizable product and service lines. Our customer base includes individual physician practices, large physician organizations, mid-sized employers, health plans, and benefit consultants / brokers.

http://www.piccorp.com/aboutus.htm

Comment:

By Don McCanne, MD

Our very expensive but highly dysfunctional system of financing health care has resulted in serious deficiencies and neglect of the infrastructure of our health care delivery system. Foremost amongst these problems is the rapid deterioration of the primary care infrastructure.

It is not as if we have remained unaware of this very serious deficiency. In fact, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association have supported the medical home concept as a model for reinforcing primary care. The label is not important. What is important is the concept that everyone should have available a primary care entry point that improves access to coordinated, comprehensive health care services. This is not about gatekeepers. It’s about everyone receiving the health care that they need.

Our dysfunctional, fragmented, multi-payer and no payer system of financing health care has been incapable of realigning incentives and appropriately allocating resources to build and maintain the primary care structure that we need. We spend more money and we get less.

Don’t worry. Aetna, in partnership with Partners in Care, has usurped the “medical home” label to… provide us with a comprehensive primary care system? Well… No. On top of our flawed systems of financing and delivering care, they are adding “customizable product and service lines.” With our system already weighted down with an excess of egregiously wasteful administrative services, they are using the medical home label to sell us even more egregiously wasteful administrative services!

Single-payer health care

Ithaca Journal

Citing the claim that a single-payer health program for the United States could realize administrative cost savings of more than $300 billion annually, the writer of the Oct. 25 letter “Too good to be true?” asks: “Can someone tell us how this enormous number was derived? What are the assumptions made in the calculation? Who did the calculation?”

The $300 billion figure is a conservative estimate derived from thorough analysis of health expenditures in the United States and Canada.

In the U.S., where private health insurance companies dominate the payment system, of every dollar, 31 cents goes to administrative expenses and 69 cents to actual health care. In Canada, where there is a single-payer national health insurance program, administration accounts for 16.7 percent of health expenditures, with 83.3 percent of spending going to the care of patients. 1999 health expenditure data, found U.S. savings to be at least $294.3 billion annually.

The study, by Woolhandler, M.D., M.P.H. et al, was published in the New England Journal of Medicine in 2003. Two authors are Harvard Medical School professors. The third is with the Canadian Institute for Health Information.

A single-payer program would not only save costs but also provide comprehensive care to everyone in the United States. Evidence indicates it will also improve quality and lessen disparities.

We need more people like the writer of the letter who want to know the evidence. Discussing the evidence — regarding human, as well as financial costs — can lead to change, like single-payer, that will improve the health of the nation.

Dr. William Klepack
Dryden

Single-payer system is the way to go

Ray Bellamy
Tallahassee Democrat
My View
November 14, 2008

Millions of families are struggling with economic hardship. Health-care costs are weighing on more Americans, contributing to about a million bankruptcies a year, and are a major factor in many home foreclosures.

Distressed companies are struggling with the rising costs of providing health coverage for their employees, and there is evidence of poorer health outcomes for the uninsured. More deaths occur from lack of insurance than because of auto accidents, leading to more deaths from cancer and chronic diseases and worse outcomes from emergency care.

One in three families is now distressed by medical costs. Yet health-care costs continue to rise faster than inflation and squeeze both families and businesses.

We pay an estimated $50 billion for health care for the uninsured and an additional estimated $180 billion in lost productivity due to employee health problems. Yet with more than $10 trillion in national debt, but assets rated at only $1.5 trillion, how can we afford to reform this dysfunctional system?

Let me show how we must undertake this task.

For-profit insurance companies must go. Their mission is to make money, and they do this best by enrolling only people who are healthy and unlikely to need care. Then, when medical expenditures are called for, the health insurers benefit by denying tests or treatments. Enormous profits for their 1,500 companies and investors are possible in this way, but at highly expensive administrative effort and waste.

Since 1970, the number of administrative personnel in the health-care industry has increased 2,500 percent, while the number of physicians has only doubled. Some health-care CEOs have reaped salary and benefits of more than $1 billion a year. Profit and overhead in the U.S. health-care industry is now 31 percent, compared with less than half of that in most other industrialized countries.

Eliminating the insurance companies and replacing them with a single-payer system such as HR 676 proposes would save our country an estimated $350 billion a year, enough to provide comprehensive health care for all of us, including dental coverage, long-term care, full pharmacy and mental-health benefits — all with no co-pays or deductibles and at no additional cost to our country beyond what we now spend on health care.

The so-called mandate plans, of which the Barack Obama campaign proposal is representative, have been tried in a number of states and have never been sustainable or successful at covering the uninsured or controlling costs.

All were plagued by soaring cost increases and failed in just a few years.

Insurance works best when the largest possible number of individuals is covered in the same risk pool, so that the healthy individuals share in the cost of paying for treatment of the sick.

Any dividing up of the risk pool by for-profit insurance companies leaves those in sicker risk pools with rising costs, whether those pools are Medicaid or other insurers.

Currently, individuals tend to switch insurance plans an average of every two years, and continuity with one’s physicians gets disrupted. So there are no incentives for the insurer to practice preventive medicine, which, because of cost reduction, tends to pay off in the long run.

HR 676 is not socialized medicine, and it is not government-run medicine. Care would be provided by private physicians, and hospitals would continue to be private. Guidance for the single-payer plan would be through health planning boards on a regional basis, appointed by state legislators and advised by medical experts. Huge savings would be realized by having only one not-for-profit insurer for everyone.

Benefits beyond the financial would be realized by having a readily accessed database on what kind of health care works and levels of utilization on a national basis. Pilot programs like HR 676 have been hugely successful. A fine example is the national health insurance in Taiwan, with an overhead of less than 2 percent, functioning well since 1995 and covering 99 percent of the Taiwanese at less than half the per-capita health-care costs of the U.S. system. Medical bankruptcy is unheard of in those countries with national health insurance.

Our organization, Physicians for a National Health Program (www.PNHP.org) represents more than 15,000 physicians and many nonphysicians who are advocating for passage of HR 676.

Several additional members of Congress were elected on Nov. 4 who advocate for this position, including one U.S. senator, Tom Udall of New Mexico. Surveys indicate about two-thirds of the public wants some form of national health insurance, and 59 percent of physicians favor this also, as well as more than half of our surveyed members of the Capital Medical Society who responded. Since it is the only comprehensive program that is affordable, can we get on about the business of passing HR 676 and let go of the idea that a private market of for-profit health insurers, with their exorbitant profits and administrative expenses, is in some way compatible with our interest?

http://www.tallahassee.com/article/20081114/OPINION05/811140323/1006/OPINION

Sen. Grassley knows a good story when he sees it

By Gilbert Cranberg
Nieman Watchdog
Commentary
November 10, 2008

AARP, which purports to be the seniors’ friend, has a lot of explaining to do to Iowa’s Senator Charles Grassley, ranking Republican on the Senate Finance Committee. In a scorching letter to AARP, Grassley implies that the organization is more interested in profiting from seniors than in serving them.

In saying AARP “purports” to be seniors’ sidekicks, I have in mind the way it exploits the belief of its members, many of them elderly, that it gives reliable, disinterested advice when it puts its name to insurance products and promotes them. Actually, it profits from what it peddles. How much does it make from the tie-ins? In a piece I wrote for this site in November 2007, I described how I questioned AARP about its financial interest in a Medicare Advantage plan it touted in behalf of United Health Care, the large and prosperous private health-care insurer. The response from an AARP spokesman: as a “private business contract” it won’t be disclosed.

AARP could stonewall me without consequence, but now it has to contend with Grassley, whose letter to AARP has “United States Senate” in big, bold letters atop the stationery. Grassley wants AARP to divulge “a detailed description of any sales commissions, inducements, incentives or other compensation offered to agents for the sale of each of the AARP insurance products.” Further, he wants to know how AARP, as an organization, “benefits financially from the sale of these policies and, if so, please provide the annual gross and net revenues to AARP from the point in time when the policies were first marketed up to the present.” Grassley set a Nov. 24 deadline for answers.

The financial data could shed important light on what really interests Grassley: why AARP sells to its members insurance policies that prove to be essentially worthless when coverage is needed.

In a press release accompanying the letter to AARP, Grassley lit into the organization:

“The pitch for these products should be straight-up and informative, instead of designed to leave the impression of being comprehensive when the product is, in fact, very limited and leaves consumers seriously in debt if they need intensive medical care. Individuals shopping in the health insurance marketplace shouldn’t be taken advantage of. A big-time advocate for health security should not target under- and un-insured Americans with misleading marketing.”

Grassley based his attack, in part, on what he learned from staffers posing as consumers shopping for coverage who were told by AARP marketers that a product, a “supplemental indemnity plan,” with flimsy coverage was “good health insurance.” The coverage was so poor that a Texas woman, Lisa Kelly, who bought it, was told by a major hospital treating her for leukemia, that it was unacceptable; the hospital even balked at changing a chemotherapy IV until her husband could show proof of payment.

AARP can take a hint; a few days after Grassley sent his letter, the organization said it would suspend marketing the inadequate supplemental benefit plan that so irked the senator.

Grassley learned about Kelly and her experience with AARP’s recommended policy from a story in the Wall Street Journal. The press as a whole, however, has been derelict in shining light on the organization’s practices and ties to the commercial insurance business. An exception has been the Des Moines Register, which ran two strong editorials Dec. 9 and 10 connending Grassley and criticizing AARP.

Senator Grassley shouldn’t have to do the press’s work for it. AARP has some 40 million members. It is a powerhouse. The press should have been all over this issue long ago. The least it can do now is pay close attention to the answers Grassley gets from AARP and from the 24 state insurance commissioners he also queried in states where the flawed AARP-backed policy is sold.

[Editor’s note: A related issue–the privatization and weakening of Medicare through Medicare Advantage plans–also cries out for press attention. See pieces on this site by Judith Stein, executive director of the Center for Medicare Advocacy.]

Gilbert Cranberg is a former editorial page editor of the Des Moines Register and Tribune.

'Medicare Advantage' a misnomer

Taxpayers foot bill for private insurance to inadequately cover seniors' health care

Jonathan D. Walker
The Journal Gazette
November 10, 2008

America has a split personality when it comes to health care. There is recognition that the government has to provide care for the people, but there is a conflicting sense that private industry has to be involved because it can somehow be more efficient. Medicare Advantage is the upshot of this thinking — but the result has been a lot of taxpayer dollars wasted on windfall payouts to private insurance companies.

With Medicare Advantage, the government is basically paying private insurance companies more money to do what Medicare could be doing more cheaply and more efficiently in the first place — if we as citizens asked it to. A lot of this extra money is not used to help the people Medicare is supposed to be helping.

Instead, the money is wasted on administrating, marketing and generating profits for insurance companies. In other words, the government is using our tax dollars to pay for the “privilege” of bringing in all the hassles of private health insurance into Medicare.

The confusing array of plans can cause less sophisticated shoppers to get stuck with very bad plans that increase their co-pays and force them to change doctors and hospitals. Careful consumers can get what seems to be a good plan because the insurance companies can use some of the money they get from the government to offer extra benefits and services.

But even smart shoppers can get into trouble. If they get sick, they will suddenly get hit with the large deductibles that go along with these plans — often thousands of dollars. To avoid these costs, patients switch back to standard Medicare once they become ill.

This scenario turns out to be a great advantage for the private insurance companies that run the Medicare Advantage plans. They use our tax dollars to get paid to do what the government could do for less, and they make even more money by covering only the healthiest seniors.

It gets even more frustrating because the healthy seniors who are getting a great deal at taxpayer expense are understandably reluctant to modify the system (as long as they stay healthy). Whenever Congress threatens to cut back on Medicare Advantage, the insurance companies can call on these seniors to contact their representatives and halt any changes.

Multiple sources have shown that the Medicare Advantage program is a waste of money, including the Medicare Payment Advisory Commission (Congress’ advisory body on Medicare payments) and the Congressional Budget Office. According to the Government Accountability Office, Medicare Advantage plans cost taxpayers 12 percent more per recipient than standard Medicare. They estimate it will cost an extra $54 billion by 2112 — about what it would cost to provide all children in America with health insurance.

And it is not just a problem of wasted taxpayer dollars. The profit motive has resulted in terrible abuses, especially with patients who have limited abilities to understand the complexity of these plans. In a hearing in 2007, Sen. Herb Kohl, D-Wis., said, “Our investigation has revealed a disturbingly consistent picture, one which only seems to be growing. Countless seniors purchasing Medicare Advantage plans have been preyed upon and unwittingly taken advantage of by insurance agents. Seniors have been removed from traditional Medicare without their knowledge, signed onto plans they can’t afford, misled regarding coverage and told their doctors accept these plans when in reality they don’t. This is simply unacceptable.”

America’s health care system is in enough trouble without wasting resources on inefficient programs that don’t give us our money’s worth — simply because powerful lobbyists get these programs enacted and then keep the programs from being cut. When organizations like the Congressional Budget Office, the Government Accountability Office and the Medicare Payment Advisory Commission tell us that there is no advantage to Medicare Advantage, we should listen.

Jonathan D. Walker , M.D., is a member of Hoosiers for a Commonsense Health Plan. He wrote this for The Journal Gazette.