PNHP

Are AHIP and PhRMA the enemies?

Are AHIP and PhRMA the enemies?

Drug coverage called key to reforming healthcare

By Jeffrey Young
The Hill
January 14, 2009
More generous insurance coverage of prescription drugs should be an essential part of any comprehensive proposal to overhaul the U.S. healthcare system, Big Pharma’s top lobbyist said Wednesday.
“Just getting insurance for everybody doesn’t do a doggone thing if it doesn’t insure the things you need and the things you ought to get in healthcare,” Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO Billy Tauzin told reporters.
“Let me say it as emphatically as I can: The pharmaceutical industry and the products we make are going to be a major part of the solution to healthcare access and affordability in this country,” said Tauzin, a former Republican House member from Louisiana.
“What we are deeply concerned about is if all of a sudden you decide to move to a single-payer system or you crowd out private competitors,” Tauzin said.
http://thehill.com/business–lobby/drug-coverage-called-key-to-reforming-healthcare-2009-01-14.html

And…

Obama, Reid take dead aim at Medicare HMOs

By Jeffrey Young
The Hill
January 14, 2009
Rep. Pete Stark (D-Calif.)… said last month that while even a Democratic bugbear like the Pharmaceutical Research and Manufacturers of America (PhRMA) should be consulted on health reform, health insurers could twist in the wind, as far as he was concerned.
“We’re not going to pass these plans if we don’t have the American Medical Association, the American Hospital Association — even PhRMA. You’re not going to get the insurance companies on board, I don’t think, but they’re the easiest to roll because nobody likes insurance companies. So, if they don’t like what we’re doing, I guess somebody has to be the bad guy,” said Stark, who chairs the Health Subcommittee of the Ways and Means Committee and will be one of the lead authors of House Democratic health reform legislation.
Stark has a sharper tongue than most of his colleagues, but his comments point up the challenges facing the health insurance industry as the health reform debate approaches.
http://thehill.com/leading-the-news/obama-reid-take-dead–aim-at-medicare-hmos-2009-01-14.html

The lobby organizations, America’s Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America (PhRMA), have been amongst the most visible targets of those of us who have been fighting for comprehensive reform that would best meet the health care needs of all of us.
AHIP represents an administratively burdensome middleman industry that has impaired health care access for their own beneficiaries while failing to provide the financial security that is the very purpose of insurance. There is no moral basis for including them in a health care system designed to best meet the needs of patients.
PhRMA represents an industry that has thrived on over-priced products that often have been marketed to professionals and the public in a dishonest manner, frequently overstating the benefits of their products while failing to adequately reveal the potential for very serious adverse consequences that their products may cause. They have also obstructed efforts for us to be sure that the prices of their products are based on reasonable costs plus fair profits.
Both organizations have earned their tarnished reputations, since their self-serving advocacy has had a serious negative impact on patient/consumers, both financially and health-wise. But there is a very crucial difference between these two entities. Pharmaceuticals are an essential component of the health care system, whereas the private insurance industry is not essential and provides us with only negative value. We need to work with the pharmaceutical industry, but we need to tell the private insurers to go “twist in the wind.”
Pete Stark is right. We do have to sit down with representatives of the health care delivery system: the drug industry (PhRMA), the hospital industry (AHA), and physicians (PNHP instead of the AMA), amongst others. But the process should prohibit up front the trade-off of beneficial policies.
Pete Stark’s Health Committee needs to lay out the policies that will best serve the interests of patients. Then, without any compromise in the fundamentals, they can work with these sectors to refine those policies in order to maintain a vibrant health care delivery system that would best serve the interests of patients. Self-seving measures that don’t benefit patients should be rejected automatically.
While Karen Ignagni is twisting in the wind (AHIP), we should honor Billy Tauzin’s white flag (PhRMA). But as he enters the reform process, he needs to be reminded that single payer isn’t about the pharmaceutical industry; it’s about health care justice for everyone in America. Therefore, it’s not negotiable.

The potential impact of the World Trade Organization's General Agreement on Trade in Services on health system reform and regulation in the United States

By Nicholas Skala
International Journal of Health Services, January 2009

This article illustrates [WTO constraints on domestic policy] through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues.

You can read the article here.

The potential impact of the World Trade Organization’s General Agreement on Trade in Services on health system reform and regulation in the United States

By Nicholas Skala
International Journal of Health Services, January 2009

This article illustrates [WTO constraints on domestic policy] through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues.

You can read the article here.

Are AHIP and PhRMA the enemies?

Drug coverage called key to reforming healthcare

By Jeffrey Young
The Hill
January 14, 2009

More generous insurance coverage of prescription drugs should be an essential part of any comprehensive proposal to overhaul the U.S. healthcare system, Big Pharma’s top lobbyist said Wednesday.

“Just getting insurance for everybody doesn’t do a doggone thing if it doesn’t insure the things you need and the things you ought to get in healthcare,” Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO Billy Tauzin told reporters.

“Let me say it as emphatically as I can: The pharmaceutical industry and the products we make are going to be a major part of the solution to healthcare access and affordability in this country,” said Tauzin, a former Republican House member from Louisiana.

“What we are deeply concerned about is if all of a sudden you decide to move to a single-payer system or you crowd out private competitors,” Tauzin said.

http://thehill.com/business–lobby/drug-coverage-called-key-to-reforming-healthcare-2009-01-14.html

And…

Obama, Reid take dead aim at Medicare HMOs

By Jeffrey Young
The Hill
January 14, 2009

Rep. Pete Stark (D-Calif.)… said last month that while even a Democratic bugbear like the Pharmaceutical Research and Manufacturers of America (PhRMA) should be consulted on health reform, health insurers could twist in the wind, as far as he was concerned.

“We’re not going to pass these plans if we don’t have the American Medical Association, the American Hospital Association — even PhRMA. You’re not going to get the insurance companies on board, I don’t think, but they’re the easiest to roll because nobody likes insurance companies. So, if they don’t like what we’re doing, I guess somebody has to be the bad guy,” said Stark, who chairs the Health Subcommittee of the Ways and Means Committee and will be one of the lead authors of House Democratic health reform legislation.

Stark has a sharper tongue than most of his colleagues, but his comments point up the challenges facing the health insurance industry as the health reform debate approaches.

http://thehill.com/leading-the-news/obama-reid-take-dead–aim-at-medicare-hmos-2009-01-14.html

Comment:

By Don McCanne, MD

The lobby organizations, America’s Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America (PhRMA), have been amongst the most visible targets of those of us who have been fighting for comprehensive reform that would best meet the health care needs of all of us.

AHIP represents an administratively burdensome middleman industry that has impaired health care access for their own beneficiaries while failing to provide the financial security that is the very purpose of insurance. There is no moral basis for including them in a health care system designed to best meet the needs of patients.

PhRMA represents an industry that has thrived on over-priced products that often have been marketed to professionals and the public in a dishonest manner, frequently overstating the benefits of their products while failing to adequately reveal the potential for very serious adverse consequences that their products may cause. They have also obstructed efforts for us to be sure that the prices of their products are based on reasonable costs plus fair profits.

Both organizations have earned their tarnished reputations, since their self-serving advocacy has had a serious negative impact on patient/consumers, both financially and health-wise. But there is a very crucial difference between these two entities. Pharmaceuticals are an essential component of the health care system, whereas the private insurance industry is not essential and provides us with only negative value. We need to work with the pharmaceutical industry, but we need to tell the private insurers to go “twist in the wind.”

Pete Stark is right. We do have to sit down with representatives of the health care delivery system: the drug industry (PhRMA), the hospital industry (AHA), and physicians (PNHP instead of the AMA), amongst others. But the process should prohibit up front the trade-off of beneficial policies.

Pete Stark’s Health Committee needs to lay out the policies that will best serve the interests of patients. Then, without any compromise in the fundamentals, they can work with these sectors to refine those policies in order to maintain a vibrant health care delivery system that would best serve the interests of patients. Self-seving measures that don’t benefit patients should be rejected automatically.

While Karen Ignagni is twisting in the wind (AHIP), we should honor Billy Tauzin’s white flag (PhRMA). But as he enters the reform process, he needs to be reminded that single payer isn’t about the pharmaceutical industry; it’s about health care justice for everyone in America. Therefore, it’s not negotiable.

Cancer Care, Simplified

“Medicare for All” is long overdue, according to cancer specialist Dr. Lou Balizet, who spoke at a health forum in Pueblo, Colorado on December 8, 2009

By Louis Balizet, M.D.

“Everybody talks about it, but nobody does anything about it.” So said Will Rogers about the weather, but he may as well have been referring to our health care system — roundly decried, but still intact. Finally, however, on both state and national levels, well designed plans have emerged to replace our current wasteful chaotic system with the only workable alternative — a single-payer, tax-financed system that eliminates private health insurance, provides universal coverage, and introduces adult supervision (centralized planning). Like the majority of American physicians, I feel that “medicare for all” is long overdue.

I am a medical oncologist who has practiced in Pueblo for 32 years. This is how I imagine my, and my patients’, lives changing under single-payer health care:

1. It will be easier, and cheaper, to administer intravenous chemotherapy to all patients. Currently, uninsured patients needing intravenous chemotherapy receive it in the hospital — a costly and inconvenient alternative to outpatient therapy.

2. Office overhead, and therefore cost, will be reduced by the elimination of the present complicated adversarial billing system, which pits armies of physicians’ employees against armies of insurance company employees (ties go to the insurance companies).

3. Inpatient cancer care will be consolidated, with benefits for patients, oncology nursing staff, and physicians. Central planning will inevitable force the cooperation,if not outright merger, of Pueblo’s two hospitals — an idea initially proposed by the administration of the two hospitals over a decade ago. (The merger was nixed by Uncle Sam’s anti-trust watchdogs, suspected by some of carrying water for the insurance companies.)

4. Approved oral chemotherapy will be available to all. At present, the indigent uninsured depend on physicians’ offices begging free oral drugs from insurance companies — a wasteful and demeaning process that, more often than not, fails to deliver needed treatment. Obviously, with financial status no longer an issue, compliance with treatment, and therefore treatment outcome, will improve.

5. Everybody, not just the insured, will be able to avail themselves of life-saving screening procedures, such as mammograms and colonoscopies. Treatment of cancer, if discovered, will be covered by single-payer universal health care. This will eliminate dangerous delays in care for fear of financial repercussions, which, believe me, happen in this community, and happen a lot.

6. Some marginally effective but outrageously expensive cancer treatments will not be available. Central planning will require the establishment of an American equivalent of Britain’s National Institute for Health and Clinical Excellence (“NICE”), charged with evaluating the value, not just the effectiveness, of new drugs, procedures, and devices. If a drug offers not cure, but only weeks more to a cancer patient’s life expectancy, and is prohibitively costly, society will not he harmed by its exclusion.

7. Consolidation of medical facilities will reach beyond hospital mergers. Pueblo currently has 6 MRI scanners and 2 CAT/PET scanners. These numbers would almost certainly be reduced under central planning, resulting in some delay, compared to now, in scheduling studies. By any rational standard, however, we have excess capacity in Pueblo; necessary studies, in an acceptable timeframe, should still be achievable.

8. Physician compensation would be determined at a state or national level. This would probably result in decreased income for specialists and increased income for primary care providers, as it has in countries with single-payer care. In addition, it would allow for bonusing doctors to practice in medically underserved areas. Pueblo has a worrisome shortage of some types of specialists but an ominous shortage of primary care providers. The present market-driven model of physician remuneration is not only incapable of addressing this problem, it is in large measure responsible for it. By ensuring that all care is remunerated, and by disproportionately rewarding practice in some areas, single-payer, centrally planned health care can do more than anything achievable under the present system to get doctors where they are needed. Enhanced access to primary care physicians would translate into earlier diagnosis of potentially serious conditions such as cancer. I would expect to see fewer advanced cases of cancer if patients did not have to consult their bank account before seeking help for their breast mass, or hoarseness, or bloody cough.

The most obvious winners under single-payer universal health care are patients, particularly those currently uninsured (now numbering upwards of 40 million, and sure to increase with the coming depression), and, I believe, doctors. However, there will be some adjustments, at times difficult. The hundreds of thousands of employees of insurance companies and hospitals and doctors’ offices who spend their entire workday wrangling over who gets to keep 15% of health care premiums will need to be redirected to more productive work — no small task, and one whose importance should not be minimized. Hospitals will revert to being service institutions instead of profit centers. Business acumen will cease to be a prerequisite for a satisfying medical practice. I have not even touched on the ramifications for the pharmaceutical industry, which will be major. However, for patients, especially cancer patients, and doctors, especially cancer doctors, the current system is unsustainable for much longer. Health Care For All Colorado, which proposes a single-payer system for our state, and Physicians for a National Health Plan, who designed a detailed national system, deserve your interest and support. Perpetuation of the current system is bad for our pocketbook, bad for our national pride, and downright malignant.

U.S. prisoners sicker than believed and have poor access to care

Harvard study also points to high social costs of undertreating mental illness

Embargoed until:
Jan. 15, 2009, 4:00 PM EST

Contacts:
Andrew P. Wilper, MD, MPH
Steffie Woolhandler, MD, MPH
Mark Almberg, (312) 782-6006

An article published today in the online edition of the American Journal of Public Health, based on the first-ever study of the health of all prison and jail inmates nationwide, reports high rates of serious illness and poor access to care among the nation’s inmate population.

The study, carried out by researchers at the Cambridge Health Alliance and Harvard Medical School, analyzed data collected from U.S. inmates in the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

Nationally, over 800,000 inmates – about 40 percent of the 2 million people in U.S. prisons and jails – reported having a chronic medical condition like diabetes, asthma or persistent heart or kidney problems, an illness rate far higher than other Americans of similar age. For example, the incidence of diabetes among federal inmates is 11.1 percent; among the age-adjusted general U.S. population, it is 6.5 percent.

The overwhelming majority of inmates surveyed were male, were younger than 35, and were disproportionately Black or Hispanic. About 10 percent were military veterans.

The researchers found that sick prisoners have poor access to care. For example, over 20 percent of sick inmates in state prisons and 13.9 percent in federal prisons had not seen a doctor or nurse since their incarceration. The same was true of 68.4 percent of jail inmates with persistent medical problems.

Besides care for physical illnesses, the authors also analyzed mental illness care among inmates both before and during incarceration. While about a quarter of inmates had a history of chronic mental illness like schizophrenia, bipolar disorder, depression or anxiety, two-thirds of them were off treatment at the time of their arrest. Only after their imprisonment did most of these inmates receive treatment.

Other key findings include the following:

* Compared to other Americans of the same age, the 1.2 million state prison inmates were 31 percent more likely to have asthma, 55 percent more likely to have diabetes, and 90 percent more likely to have suffered a heart attack.

* Access to care was worst in local jails and best in federal prisons. One-quarter of jail inmates who had suffered severe injuries had received no medical attention, versus 12 percent in state prisons and 8 percent in federal prisons.

* Inmates with medical problems like diabetes, which requires drug treatment, often had their vital medications stopped after their incarceration, including one-quarter of chronically ill state prisoners and 36.5 percent of inmates in local jails.

Dr. Steffie Woolhandler, a co-author of the study, is an associate professor of medicine at Harvard University and a primary care physician in Cambridge, Mass. She stated: “The U.S. incarcerates more people per capita than any other nation. For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration.”

Dr. Andrew P. Wilper, the study’s lead author, is currently with the University of Washington School of Medicine. He remarked: “A substantial percentage of inmates have serious medical needs. Yet many of them don’t get even minimal care medical care. These prisoners are denied their constitutionally guaranteed right to care.”

Wilper added: “Twelve million Americans are released from prisons and jails each year. These individuals and the communities to which they return suffer as many carry with them the costs of untreated illness and preventable disability. Inmates are overpaying their debt to society when they are denied access to health care.”

###

Click here for the abstract of the study.

“The Health and Health Care of U.S. Prisoners: A Nationwide Survey,” Andrew P. Wilper, MD, MPH; Steffie Woolhandler, MD, MPH; J. Wesley Boyd, MD, PhD; Karen E. Lasser, MD, MPH; Danny McCormick, MD, MPH; David H. Bor, MD; and David U. Himmelstein, MD. American Journal of Public Health, Vo. 99, No. 4.

The research was supported by a National Service Research Award.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program.

RAND COMPARE

Comprehensive Assessment of Reform Efforts (COMPARE)

RAND Health
COMPARE is a transparent, evidence-based approach to providing information and tools to help policymakers, the media, and other interested parties understand, design, and evaluate health policies.
COMPARE has four objectives:

  • Synthesize what is known about the current health care system.
  • Describe policy options that have been proposed to address one or more existing challenges.
  • Analyze the effects of different health care policy options on multiple dimensions of health system performance.
  • Identify gaps in our knowledge about the effects of policy changes.

COMPARE was developed to help public and private decisionmakers systematically assess and compare the effects of different policies across multiple dimensions of health care system performance, encompassing cost, quality, and access. COMPARE gives users a comprehensive framework in which to examine both the intended and unintended effects of changes in health care policy and to examine trade-offs across policies, or across different dimensions of performance for any particular policy (e.g., the effect on spending compared to the effect on insurance coverage or on patient experience).
The Web site includes four main sections, U.S. Health Care Today, Policy Options, Analysis of Options, and Modeling Estimates.
http://www.rand.org/health/feature/compare/
Press release:
http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/01-13-2009/0004954039&EDATE=

And…

RAND COMPARE

Policy Options – Change Insurance Coverage
* Individual Mandate
* Employer Mandate
* Purchasing Pools
* Refundable Tax Credit
* Medicaid/SCHIP Eligibility
* Open Enrollment in FEHBPModeling Estimates – Policy Options
* Tax Credit
* Medicaid Expansion
* Individual Mandate
* Employer Mandate
Who funds COMPARE?
AARP
Abraxis BioScience, Patrick Soon-Shiong MD, Founder, Chairman, and CEO
Aetna Foundation
Alcoa
Amgen Foundation
Blue Cross Blue Shield of Massachusetts
California HealthCare Foundation
The Funari Family Foundation
General Motors Foundation
Johnson & Johnson
Karen Katen
Charles N. Martin Jr., The Martin Foundation
Pacific Business Group on Health
Pfizer
RAND Corporate Endowment
RAND Health Board, designated gifts from individual members
Robert Wood Johnson Foundation
John J. Rydzewski
Leonard D. Schaeffer
The Suzanne Nora Johnson and David G. Johnson Foundation
United Health Foundation
Wellpoint Foundation
http://www.randcompare.org/
To generate custom reports:
http://www.randcompare.org/analysis/reports/

RAND COMPARE provides both a valuable information resource on U.S. health care today, and an interactive tool that can be used to evaluate the impact of various policy options under different models of reform. It has now been released for public use.
Elizabeth McGlynn and Jeffrey Wasserman are codirectors of COMPARE. On a Webinar event January 13, the release of COMPARE was announced along with a discussion of how it works. When I noted that a single, public insurance model (single payer or Medicare for all) was not an option available on the COMPARE website, Dr. McGlynn assured me that it was a model that should be added.
In their press release they stated, "An individual mandate is the most cost-effective strategy for decreasing the number of uninsured." Innumerable other studies comparing models of reform have shown that a single payer model is the most cost-effective strategy and actually eliminates the uninsured. Models based on private insurance, such as the individual mandate, have been shown to be less effective, according to these other studies.
The sponsors surely support RAND’s function as "a nonprofit research organization providing objective analysis," and would want to see that objective data on the single payer model be made available immediately for comparison with the other options.
Since we are entering a period of intense activity in health care reform, it would be helpful to have the single payer model added as expeditiously as possible. If you agree, then please send a very brief message requesting that single payer be added ASAP. Email them at: COMPARE@rand.org
You may wish to share this message with others and ask them to make the same request.

RAND COMPARE

Comprehensive Assessment of Reform Efforts (COMPARE)

RAND Health

COMPARE is a transparent, evidence-based approach to providing information and tools to help policymakers, the media, and other interested parties understand, design, and evaluate health policies.

COMPARE has four objectives:

* Synthesize what is known about the current health care system.

* Describe policy options that have been proposed to address one or more existing challenges.

* Analyze the effects of different health care policy options on multiple dimensions of health system performance.

* Identify gaps in our knowledge about the effects of policy changes.

COMPARE was developed to help public and private decisionmakers systematically assess and compare the effects of different policies across multiple dimensions of health care system performance, encompassing cost, quality, and access. COMPARE gives users a comprehensive framework in which to examine both the intended and unintended effects of changes in health care policy and to examine trade-offs across policies, or across different dimensions of performance for any particular policy (e.g., the effect on spending compared to the effect on insurance coverage or on patient experience).

The Web site includes four main sections, U.S. Health Care Today, Policy Options, Analysis of Options, and Modeling Estimates.

http://www.rand.org/health/feature/compare/

Press release:
http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/01-13-2009/0004954039&EDATE=

And…

RAND COMPARE

Policy Options – Change Insurance Coverage

* Individual Mandate
* Employer Mandate
* Purchasing Pools
* Refundable Tax Credit
* Medicaid/SCHIP Eligibility
* Open Enrollment in FEHBP

Modeling Estimates – Policy Options

* Tax Credit
* Medicaid Expansion
* Individual Mandate
* Employer Mandate

Who funds COMPARE?

AARP
Abraxis BioScience, Patrick Soon-Shiong MD, Founder, Chairman, and CEO
Aetna Foundation
Alcoa
Amgen Foundation
Blue Cross Blue Shield of Massachusetts
California HealthCare Foundation
The Funari Family Foundation
General Motors Foundation
Johnson & Johnson
Karen Katen
Charles N. Martin Jr., The Martin Foundation
Pacific Business Group on Health
Pfizer
RAND Corporate Endowment
RAND Health Board, designated gifts from individual members
Robert Wood Johnson Foundation
John J. Rydzewski
Leonard D. Schaeffer
The Suzanne Nora Johnson and David G. Johnson Foundation
United Health Foundation
Wellpoint Foundation

http://www.randcompare.org/

To generate custom reports:
http://www.randcompare.org/analysis/reports/

Comment:

By Don McCanne, MD

RAND COMPARE provides both a valuable information resource on U.S. health care today, and an interactive tool that can be used to evaluate the impact of various policy options under different models of reform. It has now been released for public use.

Elizabeth McGlynn and Jeffrey Wasserman are codirectors of COMPARE. On a Webinar event January 13, the release of COMPARE was announced along with a discussion of how it works. When I noted that a single, public insurance model (single payer or Medicare for all) was not an option available on the COMPARE website, Dr. McGlynn assured me that it was a model that should be added.

In their press release they stated, “An individual mandate is the most cost-effective strategy for decreasing the number of uninsured.” Innumerable other studies comparing models of reform have shown that a single payer model is the most cost-effective strategy and actually eliminates the uninsured. Models based on private insurance, such as the individual mandate, have been shown to be less effective, according to these other studies.

The sponsors surely support RAND’s function as “a nonprofit research organization providing objective analysis,” and would want to see that objective data on the single payer model be made available immediately for comparison with the other options.

Since we are entering a period of intense activity in health care reform, it would be helpful to have the single payer model added as expeditiously as possible. If you agree, then please send a very brief message requesting that single payer be added ASAP. Email them at: COMPARE@rand.org

You may wish to share this message with others and ask them to make the same request.

Health care tops agenda

Area's message to Obama is clear

By Laura Ungar
Louisville Courier-Journal January 8, 2009

Louisvillians had a strong message for President-elect Barack Obama yesterday: The nation’s health-care system needs either massive reforms or a complete overhaul.

“Health care in this nation costs too much and is serving too few,” said Scott Wegenast of AARP Kentucky, one of more than 80 people who attended a community health-care forum at the Brown & Williamson Club at Papa John’s Cardinal Stadium.

Sponsored by the University of Louisville, U of L Health Care, Passport Health Plan and Save the Children, it is among thousands of similar meetings being held across the nation to inform Obama’s transition team and Tom Daschle, Obama’s choice for secretary of health and human services. Organizers plan to send them a videotape of the event, results of a survey and summaries of public testimony.

Much of that testimony focused on rising insurance costs and the number of people who can’t get care. About 46 million Americans lack health insurance and, as a Courier-Journal investigation found last year, skyrocketing insurance deductibles, premiums and other insurance issues are forcing an increasing number of families to choose between finances and health.

Some speakers told personal stories.

Jessica Johnson of Louisville said she has diabetes and her husband lost his job after having a seizure at work. They tried unsuccessfully to get on Passport, a Medicaid managed-care plan, she said, and “neither of us can get the health care we need.”

David Klein of Louisville, who has leukemia, said insurance officials initially turned down a bone-marrow transplant that his doctors wanted him to have — finally approving it six months later.

“It was the only solution I had to survive,” Klein said, adding that a friend who faced a similar delay died.

A steady stream of speakers said the best solution to such problems would be a universal, single-payer health-care system similar to those in Canada and some European countries.

“President-elect Obama has said health care should be a human right and no one should profit from human illness and misery,” said Walter Tillow of Louisville.

“I agree with everything (Tillow) said,” added Mary Ann Garnar, a Medicare recipient. “I have grave concerns for the people in our country who don’t have health care. … Many suffer and die for lack of it. … This should not happen in this country.”

She said a universal health-care system run by the government “is not socialism. It is a kind and practical solution to a difficult problem.”

Several speakers expressed support for a congressional bill, HR676, which would expand Medicare to cover all Americans. One speaker held up a placard in support of the bill and another wore a T-shirt espousing health care for all.

“There is a cure for this sick health-care system — surgery to remove the health insurance companies. … ” said Dr. Garrett Adams, a retired physician who heads up the Kentucky chapter of Physicians for a National Health Program.

While the majority of speakers offering solutions supported single-payer health care, some spoke of smaller reforms, such as greater use of electronic medical records. Charlotte Beason, director of the Kentucky Board of Nursing, said more primary care providers are needed in many Kentucky counties, as are better mental health, hospice and school health care. “Quality health care must be in place,” she said.

Garnar and others said they appreciated the chance to be heard. Regular people don’t have lobbyists, she said, and “this is as close as most of us will get to speaking to our national leaders.”

Reporter Laura Ungar can be reached at (502) 582-7190. http://www.courier-journal.com/apps/pbcs.dll/article?AID=/200901080430/NEWS01/901080428

UnitedHealth "praised for major leadership effort"

Big Health Insurer Agrees to Update Its Fee Data

By Danny Hakim and Reed Abelson
The New York Times
January 13, 2009
In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.
A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.
The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.
The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected.
Because insurers typically reimburse patients for only 70 to 80 percent of the “reasonable and customary” cost of medical services when they visit doctors outside the insurer’s designated network of physicians, the patient can get shortchanged if the insurer understates the prevailing local fees.
According to Mr. Cuomo, the databases consistently understated the local “reasonable and customary” rates, which Ingenix collects from insurers. The report of the investigation’s findings described the industry calculations as “created in a well of conflicts” that produced information that was “unreliable, inadequate and wrong.”
In an interview Monday, Mr. Cuomo said: “For years this database was treated as credible and authoritative, and consumers were left to accept its rates without question. This is like pulling back the curtain on the wizard of Oz. We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”
The inability to decipher the insurer’s calculations can be overwhelming to patients with serious medical conditions.
Mary Jerome, a professor at Columbia who was found to have ovarian cancer in 2006, said she had been left with unreimbursed medical bills amounting to tens thousands of dollars. Her complaints to the attorney general’s office helped spur the investigation.
Ms. Jerome, who said she had been treated at Memorial Sloan Kettering, in large part because her primary care physician recommended the hospital, expected she would have to pay no more than her $3,000 deductible for going out of network. But she said she had soon been swamped with bills that left her $70,000 to $80,000 in debt.
Karen Ignagni, the president and chief executive of the industry trade group America’s Health Insurance Plans, praised UnitedHealth for its “major leadership effort” in reaching the agreement.
http://www.nytimes.com/2009/01/13/health/policy/13care.html?ref=business&pagewanted=all

The administrative waste of private insurers along with the excessive administrative burden they place on the health care delivery system alone is more than enough to warrant dismissing them as stewards of our health care dollars. A more fundamental moral reason to dismiss them is that they place service to patients in a secondary position to their efforts to achieve business success, frequently using dishonest deception to do so.
A prime example is this instance in which they have engaged in “a scheme to defraud” their own beneficiaries by deliberately falsifying the “reasonable and customary” cost of medical services. This is not simply an accounting trick to keep more money. This is thievery which has a negative impact on their own clients’ financial and physical health.
The experience of Professor Mary Jerome of Columbia demonstrates how nefarious this industry is. She had a $3000 deductible policy and used it at Memorial Sloan Kettering. You would think that this policy would allow her to obtain the care she needed without having to face financial hardship. But, no. She has been “swamped with bills that left her $70,000 to $80,000 in debt.”
Although New York’s attorney general has removed control of this data base from these crooks, they will continue to introduce more innovations that will enhance their bottom lines at the expense of patients and their health care professionals. The explosion in medical debt experienced by insured patients is proof that their innovations have the nefarious intent of defrauding their own beneficiaries.
And what does Karen Ignagni of AHIP have to say about this fraud? She praises UnitedHealth for its “major leadership effort.” Worse yet, what does it say about those controlling our national dialogue on reform when Karen Ignagni is included in almost every major forum, and single payer advocates such as the leadership of PNHP are deliberately excluded?
Do we really value these dishonest businessmen more than we value the health and financial security of our people?

UnitedHealth "praised for major leadership effort"

Big Health Insurer Agrees to Update Its Fee Data

By Danny Hakim and Reed Abelson
The New York Times
January 13, 2009

In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.

The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected.

Because insurers typically reimburse patients for only 70 to 80 percent of the “reasonable and customary” cost of medical services when they visit doctors outside the insurer’s designated network of physicians, the patient can get shortchanged if the insurer understates the prevailing local fees.

According to Mr. Cuomo, the databases consistently understated the local “reasonable and customary” rates, which Ingenix collects from insurers. The report of the investigation’s findings described the industry calculations as “created in a well of conflicts” that produced information that was “unreliable, inadequate and wrong.”

In an interview Monday, Mr. Cuomo said: “For years this database was treated as credible and authoritative, and consumers were left to accept its rates without question. This is like pulling back the curtain on the wizard of Oz. We have now shown that for years consumers were consistently low-balled to the tune of hundreds of millions of dollars.”

The inability to decipher the insurer’s calculations can be overwhelming to patients with serious medical conditions.

Mary Jerome, a professor at Columbia who was found to have ovarian cancer in 2006, said she had been left with unreimbursed medical bills amounting to tens thousands of dollars. Her complaints to the attorney general’s office helped spur the investigation.

Ms. Jerome, who said she had been treated at Memorial Sloan Kettering, in large part because her primary care physician recommended the hospital, expected she would have to pay no more than her $3,000 deductible for going out of network. But she said she had soon been swamped with bills that left her $70,000 to $80,000 in debt.

Karen Ignagni, the president and chief executive of the industry trade group America’s Health Insurance Plans, praised UnitedHealth for its “major leadership effort” in reaching the agreement.

http://www.nytimes.com/2009/01/13/health/policy/13care.html?ref=business&pagewanted=all

Comment:

By Don McCanne, MD

The administrative waste of private insurers along with the excessive administrative burden they place on the health care delivery system alone is more than enough to warrant dismissing them as stewards of our health care dollars. A more fundamental moral reason to dismiss them is that they place service to patients in a secondary position to their efforts to achieve business success, frequently using dishonest deception to do so.

A prime example is this instance in which they have engaged in “a scheme to defraud” their own beneficiaries by deliberately falsifying the “reasonable and customary” cost of medical services. This is not simply an accounting trick to keep more money. This is thievery which has a negative impact on their own clients’ financial and physical health.

The experience of Professor Mary Jerome of Columbia demonstrates how nefarious this industry is. She had a $3000 deductible policy and used it at Memorial Sloan Kettering. You would think that this policy would allow her to obtain the care she needed without having to face financial hardship. But, no. She has been “swamped with bills that left her $70,000 to $80,000 in debt.”

Although New York’s attorney general has removed control of this data base from these crooks, they will continue to introduce more innovations that will enhance their bottom lines at the expense of patients and their health care professionals. The explosion in medical debt experienced by insured patients is proof that their innovations have the nefarious intent of defrauding their own beneficiaries.

And what does Karen Ignagni of AHIP have to say about this fraud? She praises UnitedHealth for its “major leadership effort.” Worse yet, what does it say about those controlling our national dialogue on reform when Karen Ignagni is included in almost every major forum, and single payer advocates such as the leadership of PNHP are deliberately excluded?

Do we really value these dishonest businessmen more than we value the health and financial security of our people?

Health insurer accused of overcharging millions

UnitedHealth Group agrees to a $50 million settlement after investigation

By Melissa Dahl, Jeff Rossen and Robert Powell
msnbc.com
Tues., Jan. 13, 2009

One of the nation’s largest health insurers has agreed to pay $50 million dollars in a settlement announced today after being accused of overcharging millions of Americans for health care.

The New York attorney general’s office launched an investigation after receiving hundreds of complaints about Oxford Insurance and its parent company, UnitedHealth Group, which claims to rely on “independent research from across the health care industry” to determine reimbursement rates. In actuality though, it relies on Ingenix, a research firm owned by UnitedHealth Group.

New York Attorney General Andrew Cuomo says Ingenix has been manipulating the numbers so insurance companies pay less. In a just-released report, he contends that Americans have been “under-reimbursed to the tune of at least hundreds of millions of dollars.” Although UnitedHealth Group and Oxford Insurance were the only entities investigated, other major insurers use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield.

“This is a huge scam that affected hundreds of millions of Americans (who were) ripped off by their health insurance companies,” says Cuomo. “This was unethical, and it robbed vulnerable patients of insurance reimbursements they deserved.”

A battle on two fronts

Sixty-four-year-old Mary Jerome of Yonkers, N.Y., is one of those who complained to the attorney general. When Jerome was diagnosed with advanced ovarian cancer in 2006, she chose to go to Memorial Sloan-Kettering Cancer Center in New York, an out-of-network hospital under her insurer, Oxford, reported NBC News correspondent Jeff Rossen for the TODAY show.

The insurance company determined via Ingenix that many procedures Jerome needed — including chemotherapy medications — were not considered “usual, customary or reasonable.” After three surgeries and treatment for an embolism, Jerome was left owing $46,000.

Weakened from cancer and frightened over her finances, Jerome was fighting a battle on two fronts. She remembers “the devastation it gives to a patient who is at the worst time in their life. They’re trying to fight one battle, and then they have to fight a second battle when they have nothing — physically, spiritually, emotionally — left to fight with.”

But Jerome’s daughter, Eva, who is a Manhattan lawyer, encouraged her mother to appeal to the state’s attorney general. Jerome’s complaint was one of hundreds from angry customers, which prompted Cuomo to launch an investigation of the insurer.

“This is huge. This problem went across the country,” Nancy Nielsen, president of the American Medical Association, told the TODAY show. “It’s industry-wide, throughout insurers. So, it touched every state. Many doctors. Many millions of patients, and this has been going on for years.”

More insurers under investigation

Cuomo is now investigating other insurance companies that use Ingenix’s database to determine reimbursement rates for patients and taking steps to make sure this won’t happen again in the future.

The $50 million UnitedHealth Group will pay as the settlement will be used to create a nonprofit organization that will determine reimbursement rates for patients.

Jerome’s cancer was in remission for 20 months, but returned in October. Her employer, Columbia University, where she is a lecturer in the English department, now uses United Health Care, another insurer owned by UnitedHealth Group, the company that owns Oxford. But so far, her experience with her new insurer has been “perfect,” Jerome says. She says she’s “thrilled” with the settlement the New York attorney general’s office has reached with UnitedHealth Group.

“My main hope now and in the future is that patients won’t have to go through this,” Jerome says. “It’s much more than money; it’s being treated with honor and dignity. I think that’s what’s going to change.”

Since Jerome complained, Oxford has refunded her thousands of dollars.

In a statement, UnitedHealth Group told TODAY: “We respectfully disagree with the New York Attorney General’s findings that we manipulated data … (or that our ownership of Ingenix was a conflict of interest.) We agreed to his settlement because it was an effective way to address any perceived conflict of interest.”

Cuomo says he’s now looking into other health insurance companies for the exact thing. So, there may be millions more on the line here, as well.

In addition, some patients plan to bring a class action lawsuit against UnitedHealth Group.

URL: http://www.msnbc.msn.com/id/28628880/

(c) 2009 MSNBC.com