PNHP

New film indicts U.S. health care system

New film indicts U.S. health care system

Health, Money and Fear:


A film about our health care system

Why does it cost so much? What does it say about us? What can we do about it? By PNHP staff Dr. Paul Hochfeld, an emergency medicine physician in Corvallis, Ore., has produced and directed a new 47-minute film titled “Health, Money and Fear.” The DVD features interviews with over a dozen physicians, administrators, civic leaders and health policy experts on the problems of today’s U.S. health care “non-system” and the prospects for its reform. Among the people interviewed are Drs. Marcia Angell, Arnold Relman, Leon Eisenberg and Steffie Woolhandler, longtime advocates for single-payer national health insurance. The interviews are interspersed with footage of hospital and street scenes, charts and graphs. The quality of the video rivals that of a public television program. Hochfeld’s film touches on some of the key factors in the rising costs of care, including the administrative waste associated with the private insurance industry, new technology, pressure on physicians to produce profits, liability issues and skyrocketing drug prices. In the words of Hochfeld: “Our health care system is beyond broken or sick. It’s dumb. We spend more than twice as much per capita than most developed countries, the taxpayer is already paying for 60 percent of the total bill, and, by any measure of public health, our results are poor. … As our primary care providers continue to disappear, increasing fragmentation of care, costs will rise and outcomes will worsen. Most significantly, the insurance industry adds nothing to ‘health’ and greatly to total cost, which is increasingly a burden to our economy and threat to the financial solvency of our government. … Our health care system should be more about health and less about profits.” Hochfeld was assisted in producing the film by editor Todd Trigsted. To obtain a copy, e-mail Dr. Hochfeld at phochfeld@msn.com. He requests a donation of $0 to $25. For more information about the film, see this review in Emergency Physicians Monthly [below] or visit www.ourailinghealthcare.com.

Review of Health, Money and Fear

By Logan Plaster DVD review Emergency Physicians Monthly Jan. 7, 2009 Health, Money and Fear Paul Hochfeld had enough. After nearly 30 years practicing emergency medicine in Oregon he was sick and tired of ordering tests that people didn’t need and having no responsible limits on expensive end-of-life care. He felt that the health care system was imploding and he was at the center. So what did he do? He picked up a video camera, of course, and began making a documentary. It didn’t happen overnight. In fact, if you’d told Hochfeld three summers ago, when he enrolled in his first (and only) video production class, that he would be screening his own health care documentary at the 2008 Boston Film Festival, he would have called you delusional. A few years back, Hochfeld was just dabbling, producing small video projects for friends. He traveled to Tanzania to document the building of a new school and then made a video for a humanitarian water project in Kenya. But the bug for Hochfeld’s current project didn’t take hold until the day he saw “Why We Fight,” a documentary by Eugene Jarecki. The film raises questions about the influence of America’s military industrial complex — the largest industry in the country — over public policy. As interesting as this was, for Hochfeld, it pointed to another question: How is the health care system — America’s second largest industry — hijacking public policy? “I think the seeds of the video started with that,” Hochfeld says. Hochfeld didn’t really know where he was heading, but he began with the working title: “Our Ailing Health Care: A Physician Explores the Illness.” At first, he simply went to the library and checked out books and journals, boning up on his facts. “I had never really explored it at that level before,” says Hochfeld. As he came across people in his reading who seemed to have interesting things to say about the health care system, he tracked down their information, contacted them, and asked them if he could conduct an interview. Much to his surprise, most of them said yes. “It was unbelievable actually,” he recalls. Hochfeld ended up arranging seven interviews between Boston and Atlanta. He took a week and half out of his schedule, flew to the East Coast and began traveling from city to city. In terms of production, the original plan was to go simple: two cameras, no operator. Just Hochfeld and the interviewee. “It was going to be a one-man show,” says Hochfeld with a laugh. “Yeah, right.” After realizing that this wasn’t going to cut it, Hochfeld teamed up with another film maker, his instructor from a video production class he’d taken a couple years prior. Hochfeld credits this move with making a “huge difference” in the final product. “I think what makes my video work is that even though it’s just an ER doctor doing it, it does have the feel of a professional production.” Hochfeld completed his interviews in the Spring of 2007, let the tapes sit for the summer, and then entered the editing room last Fall. He whittled and chopped until the piece was a concise 47-minute documentary which he titled “Health, Money and Fear.” These days Paul Hochfeld can be found in Corvallis, Oregon, showing his film to various groups of interested doctors and medical academics. They watch the film and then engage in a discussion of the topics in the film. It’s a grassroots effort, but Hochfeld couldn’t be happier with the result. “People really like it,” says Hochfeld. “I think it resonates with a lot of people’s truth.” That “truth,” as portrayed by the film, is the idea that a single-payor health care system could save the country untold millions of dollars through such avenues as liability reform, a national EMR, regulations put on pharmaceutical pricing, and adequate pay for primary care physicians. “Our health care system is a bizarre blend of the worst of capitalism and the worst of socialism,” says Hochfeld. On the socialist side, he explains, you have the patient “with chest pain who one year previously received a cardiac stint on public money who is still smoking, expecting us to do it again.” On the capitalist side, “you have hospitals spending huge amounts of money on proton beam accelerators to marginally help old men have longer survival from prostate cancer, because it pays well, not because it is a good investment of our health care dollars.” When he gets back from the Boston Film Festival, Hochfeld plans to contact those people who have shown an interest in the film and pursue a multi-city tour in which he shows the video and leads discussions around the country. He doesn’t care about getting paid; he’s asking only that his traveling expenses be covered. His aim is simple: use the film as an educational device and a political tool to affect real health care change. Hochfeld concludes the film with this plea: “We need to get over our fear of the government and embrace the idea that in health care, somebody needs to be in charge, so that we can keep our eye on the prize, which is health, not profits.”

CMS requirements for medical suppliers – a bureaucratic boondoggle?

Change in law costs medical supply firms

By Karen Shideler
The Wichita Eagle
January 8, 2009
Businesses that provide durable medical equipment, such as hospital beds and bottled oxygen, are being hit by more paperwork and new costs because of new federal requirements.
The Centers for Medicare and Medicaid Services are requiring most durable medical equipment suppliers to post a surety bond of $50,000 and to be accredited.
The federal requirements are, in part, the result of efforts to fight Medicare fraud and abuse. Medicare recently announced that it was revoking billing privileges of more than 1,100 medical equipment suppliers in south Florida and the Los Angeles area after an investigation found about $1 billion in improper payments.
In a news release, CMS acting administrator Kerry Weems said, “We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare.”
“It’s more work and, let’s face it, it’s money out of our pocket,” said Leon Deaver, owner of Kimzey-Eilert Medical Supplies.
Bruce Schneider, owner and pharmacist at Hart Pharmacy & Home Medical Equipment, estimated the new requirements will cost him $20,000.
Brian Dechant, director of sales at Therapeutic Medical Supply, said the accreditation requirement doubles or triples the amount of paperwork required.
“If you’re running your operations like you should be, it’s not a real big thing,” Dechant said. He said his company was recently accredited for a three-year period. “It requires you to follow a certain set of standards… They review them, make sure everything’s kosher, then they actually look at our processes.”
Schneider said he has seen estimates that 28 percent of medical equipment suppliers nationwide could be out of business a year from now because of the new requirements.
But he and Dechant both said they expected the number in Wichita to hold steady. “We’re generally honest, good people,” Dechant said.
He, Schneider and Deaver all said the new requirements aren’t all bad.
For Schneider, they’ve resulted in some streamlining.
Deaver said they should help assure customers, too.
“We’re taking a very positive attitude, that it will help us do things better,” he said.
http://www.kansas.com/business/health-care/story/655455.html

A frequent complaint about government financing of health care is that government bureaucrats place an excessive administrative burden on the health care delivery system. This charge has already been refuted by studies demonstrating the much greater administrative excesses and waste of the private insurance industry when contrasted with a public program such as Medicare.
Nevertheless, when the government introduces a program to improve value in health care purchasing, such as this program to accredit medical equipment suppliers, howls of protest arise from the anti-government forces. This article on “more paperwork and new costs because of new federal requirements” provides these protesters with more support. Or does it?
It is only natural that honest businessmen who are trying to provide quality products and services would be annoyed with new government requirements. But they understand that the taxpayers should not be expected to pay a billion dollars to crooks that permeate their own industry. They also admit that these new requirements “aren’t all bad,” that they have motivated “some streamlining,” and that they will help “assure customers” of the integrity of this industry that has been given a black eye by the the nefarious element amongst them.
How would the private insurance industry have handled this? Would they have used their very large pool of administrative funds to require accreditation and surety bonds of the suppliers? No. They use their administrative funds to write and market innovative plans that don’t even cover these supplies and services. When they do provide this coverage with premium plans, they burn up more administrative dollars to be sure that they sell these more comprehensive plans only to those healthy individuals who would be less likely to need these benefits. An obvious irony is that these administrative costs for the private insurers are much greater than would be a program of accreditation and surety bonds.
Never fear. As with other Medicare administrative efficiencies, the private insurers will get a free ride by using the Medicare lists of accredited suppliers. Once again, the taxpayer foots the bill, while the private insurers take their spoils to the bank.

CMS requirements for medical suppliers – a bureaucratic boondoggle?

Change in law costs medical supply firms

By Karen Shideler
The Wichita Eagle
January 8, 2009

Businesses that provide durable medical equipment, such as hospital beds and bottled oxygen, are being hit by more paperwork and new costs because of new federal requirements.

The Centers for Medicare and Medicaid Services are requiring most durable medical equipment suppliers to post a surety bond of $50,000 and to be accredited.

The federal requirements are, in part, the result of efforts to fight Medicare fraud and abuse. Medicare recently announced that it was revoking billing privileges of more than 1,100 medical equipment suppliers in south Florida and the Los Angeles area after an investigation found about $1 billion in improper payments.

In a news release, CMS acting administrator Kerry Weems said, “We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare.”

“It’s more work and, let’s face it, it’s money out of our pocket,” said Leon Deaver, owner of Kimzey-Eilert Medical Supplies.

Bruce Schneider, owner and pharmacist at Hart Pharmacy & Home Medical Equipment, estimated the new requirements will cost him $20,000.

Brian Dechant, director of sales at Therapeutic Medical Supply, said the accreditation requirement doubles or triples the amount of paperwork required.

“If you’re running your operations like you should be, it’s not a real big thing,” Dechant said. He said his company was recently accredited for a three-year period. “It requires you to follow a certain set of standards… They review them, make sure everything’s kosher, then they actually look at our processes.”

Schneider said he has seen estimates that 28 percent of medical equipment suppliers nationwide could be out of business a year from now because of the new requirements.

But he and Dechant both said they expected the number in Wichita to hold steady. “We’re generally honest, good people,” Dechant said.

He, Schneider and Deaver all said the new requirements aren’t all bad.

For Schneider, they’ve resulted in some streamlining.

Deaver said they should help assure customers, too.

“We’re taking a very positive attitude, that it will help us do things better,” he said.

http://www.kansas.com/business/health-care/story/655455.html

Comment:

By Don McCanne, MD

A frequent complaint about government financing of health care is that government bureaucrats place an excessive administrative burden on the health care delivery system. This charge has already been refuted by studies demonstrating the much greater administrative excesses and waste of the private insurance industry when contrasted with a public program such as Medicare.

Nevertheless, when the government introduces a program to improve value in health care purchasing, such as this program to accredit medical equipment suppliers, howls of protest arise from the anti-government forces. This article on “more paperwork and new costs because of new federal requirements” provides these protesters with more support. Or does it?

It is only natural that honest businessmen who are trying to provide quality products and services would be annoyed with new government requirements. But they understand that the taxpayers should not be expected to pay a billion dollars to crooks that permeate their own industry. They also admit that these new requirements “aren’t all bad,” that they have motivated “some streamlining,” and that they will help “assure customers” of the integrity of this industry that has been given a black eye by the the nefarious element amongst them.

How would the private insurance industry have handled this? Would they have used their very large pool of administrative funds to require accreditation and surety bonds of the suppliers? No. They use their administrative funds to write and market innovative plans that don’t even cover these supplies and services. When they do provide this coverage with premium plans, they burn up more administrative dollars to be sure that they sell these more comprehensive plans only to those healthy individuals who would be less likely to need these benefits. An obvious irony is that these administrative costs for the private insurers are much greater than would be a program of accreditation and surety bonds.

Never fear. As with other Medicare administrative efficiencies, the private insurers will get a free ride by using the Medicare lists of accredited suppliers. Once again, the taxpayer foots the bill, while the private insurers take their spoils to the bank.

Conyers: Obama should not nominate Sanjay Gupta

By Sam Stein
Huffington Post
January 8, 2009

Rep. John Conyers has written a letter to Democratic colleagues urging them to join him in publicly opposing the nomination of Dr. Sanjay Gupta for Surgeon General.

Conyers, the veteran Judiciary Committee chairman, writes that Gupta “lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance,” and requests that fellow Democrats join him “in signing a letter to President-Elect Barack Obama that Dr. Sunjay Gupta not be nominated for the post.”

Here’s the bulk of the Dear Colleague letter:

“I join in opposition with respected Noble Peace Prize award wining economist Paul Krugman, who has very serious concerns with having Dr. Gupta be the nation’s Surgeon General. […]

“Also, there are highly experienced medical professionals who question whether Dr. Gupta has the necessary experience or even the medical background to be in charge of some 6,000 physicians or more who work in the United States Public Health Service. Gerard M. Farrel, executive director of the Commissioned Officers Association, stated in the January 7, 2008, Washington Post that Dr. Gupta will certainly face a ‘credibility gap’ because he never served in the National Health Service Corps, and furthermore, does not have the ‘experience or qualifications to be the leader of the nation’s public health service.’ Clearly, it is not in the best interests of the nation to have someone like this who lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance to some of the poorest and most underserved communities in America.”

Conyers’ letter represents one of the first critical takes on the potential Gupta nomination to come from the Hill. In most quarters, reports about the CNN medical correspondent have been greeted as a smart, if not provocative, pick. Howard Dean, a doctor himself, noted that Gupta’s responsibilities would be much the same as those in his current job: explaining medical issues of public concern in a manner that the public could understand.

Outside of government, however, some have begun questioning whether the CNN correspondent has the proper qualifications to be Surgeon General. Krugman, in his post noted that Gupta accused filmmaker Michael Moore of inaccuracies, “when the truth was that on every one of the allegedly fudged facts, Moore was actually right and CNN was wrong.” Gupta and CNN would later acknowledge making a mistake and apologize on air. Others have questioned whether he is the right conduit for Obama’s health care agenda, and whether or not he has ethical conflicts of interest stemming from the corporate sponsors of his show.

But while Conyers and these individuals have doubts, it’s unclear whether the post of Surgeon General will elicit much of a fight, since no Senators (who must confirm the nomination) have spoken critically of Gupta.

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009
(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.
For many Texans, it hasn’t worked out that way.
“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.
Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.
Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.
“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.
“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”
Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.
Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.
“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”
The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”
http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.
Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?
And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.
Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

UnitedHealth's Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009

(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.

For many Texans, it hasn’t worked out that way.

“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.

Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.

Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.

“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.

“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”

Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.

Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.

“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”

The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”

http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

Comment:

By Don McCanne, MD

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.

Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?

And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.

Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

Memo to Obama: Seize the Moment for National Health Insurance

By John Geyman, MD
Tikkun magazine
January-February 2009

First off, congratulations to you and your party on your sweeping election results!

Together with a sizable majority of Americans, I am again hopeful for the future of our country. My special concern, however, is for our failing health care system and how it is pricing health care beyond the reach of ordinary Americans. Our system has come to the point where none of the many incremental reforms will work. The business model of insurance has failed, and we need to rebuild the system on a social insurance model.

Let me be direct. Although we have many dedicated health professionals, an abundance of the latest technologies, and many fine hospitals, health care has become just another commodity to be bought and sold in a deregulated market based on ability to pay, not medical need. As you well know, industry profits handsomely from the status quo, raking in money through insurance, pharmaceuticals, medical devices, and so on. Industry has a war chest to defend itself and demonstrates its political power each time any new reform is brought up.

But the situation has become dire. There is no end in sight in controlling health care costs as they soar upwards at three or four times the cost of living and family incomes. We have had three decades of incremental attempts to rein in costs, including managed care and consumer-directed health care. None have worked. We have a solution in plain sight — single-payer National Health Insurance (NHI). Market stakeholders are fighting it fiercely, but it’s the only real reform that has a chance to work.

Most of your advisers will likely caution you that NHI is too radical for Americans to accept, that you need to be more centrist, and that it is not politically feasible. But therein lies your trap. You will be persuaded to add one more incremental attempt to fix things, which will not work, will cost more than ever, will delay real reform, and will add to the pain of so many along the way. Your moment of opportunity will have been lost.

Beyond ideology, these facts support NHI as the treatment of choice in 2009.

* Premiums alone for private health insurance have grown by more than 100 percent since 2000, and are projected to consume all of average household income by 2025, clearly an impossibility way before then.

* According to the Milliman Medical Index, the typical American family of four spent $15,600 on total health care costs in 2008, fully one-quarter of the typical combined family income of $60,000; most consider 10 percent of family income to be the threshold of underinsurance.

* The administrative overhead of private insurers is five to nine times higher than not-for-profit Medicare (average for commercial carriers 19.9 percent, investor-owned Blues 26.5 percent, Medicare 3 percent).

* The inefficiency and bureaucracy of our 1,300 private insurers are not sustainable (e.g., according to the Blue Cross Blue Shield Association, there are 17,000 different hea1th plans in Chicago).

* Private insurers offer much less choice than traditional Medicare; there are near-monopolies in 95 percent of HMO/PPO metropolitan markets, enough to trigger anti-trust concerns by the United States Department of Justice.

* Because of costs, about 75 million Americans are either uninsured of underinsured, with large segments of the population forgoing necessary care and having worse health care outcomes; the United States now ranks nineteenth among nineteen industrialized countries in reducing preventable deaths from amenable causes.

* Wall Street is already questioning the future prospects of the private insurance industry; as of November 18, 2008, the average share prices of the top five private insurers were down by between 60 percent and 77 percent, compared to the Standard and Poor’s 42 percent.

I expect that none of this is news to you, but what is neglected by almost all economists, “experts” and pundits is that there is already plenty of money in the system, that we waste about one-third of our health care dollar on our inefficient multi-payer financing system and on unnecessary care, and that NHI will save money, not cost more. NHI is the most fiscally responsible thing we can do now about health care. The Conyers bill in the House (H.R. 676) will be financed by payroll and progressive income taxes that will be less than what individuals and employers now pay. The health insurance industry is being propped up by government subsidies to the employer-based system and to privatized public programs. NHI can save some $350 billion through administrative simplification, while offering coverage for all necessary care, full choice of provider and hospital, and mechanisms for cost containment through bulk purchasing, negotiated fees, and global budgets.

NHI by itself will not solve all of our health care problems, but it will provide a structure (as no incremental approach can) to enable other necessary steps. These include acceptance of health care as a right, transition to a not-for-profit system, reimbursement reform, rebuilding of primary care, evidence-based technology assessment, and quality improvement. None of this will be possible by using reforms that leave an obsolete private insurance industry in place, as is more fully discussed in my recent book “Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It.”

FDR almost went for NHI in the mid-1930s, but he backed off, mainly due to the AMA’s opposition. Today, the AMA is marginalized with a membership of no more than 30 percent of physicians, and a majority of American physicians now support NHI. Implementing NHI in your presidency can be your FDR-size legacy. It has become an economic, moral, and social imperative. Overnight NHI can bind us together as one society, all of us in the same boat. We can afford it. Yes, we can!

John P. Geyman, M.D., is professor emeritus of family medicine at the University of Washington, and past president of Physicians for a National Health Program. He is a member of the Institute of Medicine.

UnitedHealth’s Evercare

Is Texas looking out for you? Health-care outsourcing is rolling on, but many patients suffer from silent treatment

By Gregg Jones
The Dallas Morning News
January 4, 2009

(UnitedHealth’s) Evercare of Texas was supposed to coordinate medical and long-term care for more than 80,000 elderly, blind or disabled North Texans. “We help make it easier to get the care you deserve,” the company promises on its Web site.

For many Texans, it hasn’t worked out that way.

“They ought to call them ‘Nevercare,’ ” said (Mary) Hunt, among the hundreds of people who have complained about denied or delayed medical care.

Evercare’s health management program is just one of a growing list of outsourcing efforts embraced by Gov. Rick Perry and the Texas Legislature as a way to save money while still delivering state-funded care. But rather than providing a surrogate safety net, private contractors have failed needy Texans and taxpayers.

Texas is near the bottom among the 50 states in per-capita spending on health and human services, but it is a leader in outsourcing these functions to private contractors. Since taking office in 2000, Perry has pushed some of the nation’s most ambitious outsourcing endeavors, going well beyond his predecessor, George W. Bush.

“We have a leadership that believes the private sector does things better,” said Celia Hagert, senior policy analyst and privatization expert at the Center for Public Policy Priorities, a nonpartisan research group in Austin.

“Whether it’s ideology or philosophy — simply believing that people shouldn’t be on these programs in the first place — these things have combined to create a very stingy social safety net system in Texas.”

Since 2000, the Texas Department of Insurance has fined UnitedHealth or one of its units seven times totaling more than $10 million for violations involving claims payouts, reporting requirements and other problems.

Texas doctors have long complained about UnitedHealth and its handling of claims under employer-provided insurance plans.

“They’re dishonest, and they’re sneaky,” said Dr. William Walton, a family doctor in North Dallas. “If you’re not really on top of it, you’ll lose lots of money working with United Healthcare.”

The fines haven’t changed UnitedHealth’s way of doing business, he said, adding, “That’s just a cost of business in their eyes.”

http://www.dallasnews.com/sharedcontent/dws/news/texassouthwest/stories/DN-son1mainbar_04pro.ART.State.Edition2.4a74df6.html

Comment:

By Don McCanne, MD

So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.

Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?

And the next step in reform? Not only more rules and more knuckle rapping for the private insurers, but now new rules and new knuckle rapping for the tens of millions of uninsured individuals who cannot afford to purchase private health insurance.

Does our new political leadership share the fantasies of Bush and Perry that the private insurance sector does things better? Hopefully not, but it’s looking more and more like they do. Establishing a single payer health financing infrastructure would automatically eliminate these perversities. Why has that been taken off the table?

Headlines on slowing in health care spending miss the real story

National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998

By Micah Hartman, Anne Martin, Patricia McDonnell, Aaron Catlin the National Health Expenditure Accounts Team – Centers for Medicare and Medicaid Services (CMS) Office of the Actuary
Health Affairs
January/February 2009
In 2007, U.S. health care spending growth slowed to its lowest rate since 1998, increasing 6.1 percent to $2.2 trillion, or $7,421 per person. The health care portion of gross domestic product reached 16.2 percent, up from 16.0 percent in 2006. Slower growth in 2007 was largely attributed to retail prescription drug spending and government administration. With the exception of prescription drugs, most other health care services grew at about the same rate as or faster than in 2006. Spending growth from private sources accelerated in 2007 as public spending slowed; however, public spending growth has continued to outpace private sources since 2002.
http://content.healthaffairs.org/cgi/content/abstract/28/1/246

This annual CMS report on health care spending is being celebrated in headlines throughout the nation as demonstrating a slowing in the growth of health care spending. Such headlines are missing the terrible news in this report.

  • Most health care spending growth did not slow. The overall rate was lower partially due to decreases in drug costs, especially because many block-buster drugs came off of patent, and generic prescribing increased disproportionately. The increase in Medicare spending for 2006 was 18.5 percent, primarily because of the costs of the Part D drug benefit and the higher costs of the Medicare Advantage plans. Increases in Medicare spending for 2007 were still fairly high at 7.2 percent, but the decline from an extremely high percentage increase to a high percentage increase may be a decline in the rate of increase, but is still a very large increase. Next year’s report on the rate increases for 2008 likely will not reflect these downward distortions.
  • Even with the downward adjustments, the overall rate of increase was still 6.1 percent, well in excess of the rate of inflation. A smaller increase over the rate of inflation cannot be interpreted as good news when the problem of increased costs is growing progressively worse.
  • A very small but extremely important number in this report is that the percent increase in health care as a portion of our gross domestic product (GDP) was 0.2 percent, an increase from 16.0 percent to 16.2 percent. How can you celebrate a decline in the rate of increase in costs when those costs continue to encroach on our other spending?

Health care spending is in a crisis mode, and it only gets worse. Congress and the administration must act, but what do they intend to do? They are going to enact laws and regulations requiring us to give money to the private insurance industry to act as stewards of our health care dollars.
Yes, the insurers will be told to do a good job (through regulation), and when they fail (which they will), what will be their response? The same as now: Doctors and patients and hospitals and drug firms and tech firms keep running up the costs, and we can’t do anything about it.
Well, they’re right; they can’t. But the people can, by convincing Congress to enact our own single payer national health program – a program through which we can demand greater value in our health care purchasing.

Headlines on slowing in health care spending miss the real story

National Health Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998

By Micah Hartman, Anne Martin, Patricia McDonnell, Aaron Catlin the National Health Expenditure Accounts Team – Centers for Medicare and Medicaid Services (CMS) Office of the Actuary
Health Affairs
January/February 2009

In 2007, U.S. health care spending growth slowed to its lowest rate since 1998, increasing 6.1 percent to $2.2 trillion, or $7,421 per person. The health care portion of gross domestic product reached 16.2 percent, up from 16.0 percent in 2006. Slower growth in 2007 was largely attributed to retail prescription drug spending and government administration. With the exception of prescription drugs, most other health care services grew at about the same rate as or faster than in 2006. Spending growth from private sources accelerated in 2007 as public spending slowed; however, public spending growth has continued to outpace private sources since 2002.

http://content.healthaffairs.org/cgi/content/abstract/28/1/246

Comment:

By Don McCanne, MD

This annual CMS report on health care spending is being celebrated in headlines throughout the nation as demonstrating a slowing in the growth of health care spending. Such headlines are missing the terrible news in this report.

* Most health care spending growth did not slow. The overall rate was lower partially due to decreases in drug costs, especially because many block-buster drugs came off of patent, and generic prescribing increased disproportionately. The increase in Medicare spending for 2006 was 18.5 percent, primarily because of the costs of the Part D drug benefit and the higher costs of the Medicare Advantage plans. Increases in Medicare spending for 2007 were still fairly high at 7.2 percent, but the decline from an extremely high percentage increase to a high percentage increase may be a decline in the rate of increase, but is still a very large increase. Next year’s report on the rate increases for 2008 likely will not reflect these downward distortions.

* Even with the downward adjustments, the overall rate of increase was still 6.1 percent, well in excess of the rate of inflation. A smaller increase over the rate of inflation cannot be interpreted as good news when the problem of increased costs is growing progressively worse.

* A very small but extremely important number in this report is that the percent increase in health care as a portion of our gross domestic product (GDP) was 0.2 percent, an increase from 16.0 percent to 16.2 percent. How can you celebrate a decline in the rate of increase in costs when those costs continue to encroach on our other spending?

Health care spending is in a crisis mode, and it only gets worse. Congress and the administration must act, but what do they intend to do? They are going to enact laws and regulations requiring us to give money to the private insurance industry to act as stewards of our health care dollars.

Yes, the insurers will be told to do a good job (through regulation), and when they fail (which they will), what will be their response? The same as now: Doctors and patients and hospitals and drug firms and tech firms keep running up the costs, and we can’t do anything about it.

Well, they’re right; they can’t. But the people can, by convincing Congress to enact our own single payer national health program – a program through which we can demand greater value in our health care purchasing.

Another middleman, with a Donald Trump wig!

Dallas’ American CareSource sees stock jump 120% in 2008

By Jason Roberson
The Dallas Morning News
January 2, 2009
American CareSource is the nation’s first publicly traded ancillary care network company. The company basically serves as a middleman, connecting payors, such as insurers, with the providers of such services as lab work and diagnostic imaging.
Ancillary services now represent 30 percent of health care expenditures, valued at $574 billion annually, according to U.S. Center for Medicare and Medicaid Services.
While most insurers can handle the 70 percent of health care dollars that go to hospitals and physicians, the largest insurers form networks with ancillary services. That’s where American CareSource comes in.
American CareSource targets smaller insurers, unions and employers that aren’t able on their own to purchase ancillary services in bulk.
(American CareSource) bills itself as a cost-saver to both payors and ancillary providers. It acts as the providers’ advocate by collecting hard-to-get payments from insurance claims; it serves as the insurers’ advocate by offering lower costs than they could get on their own.
“In some ways, we want to be the Wal-Mart or Target of health care,” said David Boone, CEO of American CareSource.
He maintains a small-company management style. Whenever a new client is secured, an old ship’s bell is rung in celebration. When the company hit $1 million in profit, Boone, as promised, strutted in the middle of the office and proceeded to do a “money dance,” wearing a Donald Trump wig, a comical green jacket and hat of dollar bills.
http://www.dallasnews.com/sharedcontent/dws/bus/stories/010309dnbuscaresource.38426b8.html

As long as we insist that health care continue to be financed through our dysfunctional, fragmented multi-payer system, we will continue to see more innovative middlemen organizations capturing and siphoning away dollars that should be directed to health care instead.
Now we have a for-profit, publicly-traded entity that adds an additional, expensive administrative layer between the health plans and the providers of ancillary services. American CareSource provides no health care products or services – only more administrative waste.
I don’t know about you, but I’ve grown weary listening to those who say that single payer advocates have failed to demonstrate that a single payer system would bring us more than only nominal, one-time savings in administrative costs. Go to the PNHP website (www.pnhp.org) and type in “administrative waste” in the search window at the top of the opening page, but be prepared to spend a lot of time.
Massive, middlemen administrative waste permeates our entire health care system. It is not limited to the excesses of the private insurance industry, though that industry is a major contributor, both directly in its own costs, and indirectly by the burden placed on the health care delivery system. There are a great many other innovative administrative organizations involved, often subsidiaries of the insurers.
These same individuals who discredit the potential for recovering administrative waste also fail to mention the other benefits of single payer such as true universality, equity, efficiency, improved value in health care purchasing, and humane methods of cost containment.
But I have to hand it to David Boone, CEO of American CareSource. What could be more appropriate for this entrepreneurial middleman organization than celebrating success with a ship’s bell, a Donald Trump wig, and a hat stuffed with dollar bills? How fitting!
This should inspire the insurance industry’s AHIP. When Congress passes health care reform based on private health plans, AHIP can pass out the Donald Trump wigs with the hats stuffed with money. But the bell? Shipping in that bell from Philadelphia won’t do since it has a crack in it. That’s okay. Piping in the opening bell of the NYSE would much more befit the occasion anyway.

Another middleman, with a Donald Trump wig!

Dallas' American CareSource sees stock jump 120% in 2008

By Jason Roberson
The Dallas Morning News
January 2, 2009

American CareSource is the nation’s first publicly traded ancillary care network company. The company basically serves as a middleman, connecting payors, such as insurers, with the providers of such services as lab work and diagnostic imaging.

Ancillary services now represent 30 percent of health care expenditures, valued at $574 billion annually, according to U.S. Center for Medicare and Medicaid Services.

While most insurers can handle the 70 percent of health care dollars that go to hospitals and physicians, the largest insurers form networks with ancillary services. That’s where American CareSource comes in.

American CareSource targets smaller insurers, unions and employers that aren’t able on their own to purchase ancillary services in bulk.

(American CareSource) bills itself as a cost-saver to both payors and ancillary providers. It acts as the providers’ advocate by collecting hard-to-get payments from insurance claims; it serves as the insurers’ advocate by offering lower costs than they could get on their own.

“In some ways, we want to be the Wal-Mart or Target of health care,” said David Boone, CEO of American CareSource.

He maintains a small-company management style. Whenever a new client is secured, an old ship’s bell is rung in celebration. When the company hit $1 million in profit, Boone, as promised, strutted in the middle of the office and proceeded to do a “money dance,” wearing a Donald Trump wig, a comical green jacket and hat of dollar bills.

http://www.dallasnews.com/sharedcontent/dws/bus/stories/010309dnbuscaresource.38426b8.html

Comment:

By Don McCanne, MD

As long as we insist that health care continue to be financed through our dysfunctional, fragmented multi-payer system, we will continue to see more innovative middlemen organizations capturing and siphoning away dollars that should be directed to health care instead.

Now we have a for-profit, publicly-traded entity that adds an additional, expensive administrative layer between the health plans and the providers of ancillary services. American CareSource provides no health care products or services – only more administrative waste.

I don’t know about you, but I’ve grown weary listening to those who say that single payer advocates have failed to demonstrate that a single payer system would bring us more than only nominal, one-time savings in administrative costs. Go to the PNHP website (www.pnhp.org) and type in “administrative waste” in the search window at the top of the opening page, but be prepared to spend a lot of time.

Massive, middlemen administrative waste permeates our entire health care system. It is not limited to the excesses of the private insurance industry, though that industry is a major contributor, both directly in its own costs, and indirectly by the burden placed on the health care delivery system. There are a great many other innovative administrative organizations involved, often subsidiaries of the insurers.

These same individuals who discredit the potential for recovering administrative waste also fail to mention the other benefits of single payer such as true universality, equity, efficiency, improved value in health care purchasing, and humane methods of cost containment.

But I have to hand it to David Boone, CEO of American CareSource. What could be more appropriate for this entrepreneurial middleman organization than celebrating success with a ship’s bell, a Donald Trump wig, and a hat stuffed with dollar bills? How fitting!

This should inspire the insurance industry’s AHIP. When Congress passes health care reform based on private health plans, AHIP can pass out the Donald Trump wigs with the hats stuffed with money. But the bell? Shipping in that bell from Philadelphia won’t do since it has a crack in it. That’s okay. Piping in the opening bell of the NYSE would much more befit the occasion anyway.