PNHP

What About Single Payer?

What About Single Payer?

An Answer to the Question About How to Reform Our Health Care System

By Drs. Edward P. Ehlinger and Susanne L. King
Your Voice
MetroDoctors
The Journal of the East and West Metro Medical Societies
July/August 2008

In discussions of health care reform, consensus is rapidly developing around the urgent need for universal health care coverage in the United States. There is also an almost universal understanding that this coverage is not feasible without cost containment. Given the facts that over 47 million people in the U.S. are uninsured and an even greater number are underinsured and that the percentage of the U.S. Gross Domestic Product (GDP) going to health care is over 16 percent, it’s not surprising that the issues of access and cost have become priority issues in our country.

An increasing number of health care professionals and policy makers are claiming that a single-payer system is the only rational approach that can actually contain costs, achieve universal coverage, and maintain or improve quality. They argue that only a single-payer approach can address the economic pressure on businesses and the rising costs of health care for individuals and still be able to expand coverage to everyone. However, these statements are guaranteed to bring forth a series of questions about single payer. Here are responses to some of the questions that are frequently raised.

1) What is single-payer health care?

“Single payer” means that there is one payer — one insurer — who reimburses health care providers for their services. This is in contrast to the current system that provides payment through multiple insurance companies. This one payer has the authority to negotiate limits on what providers, pharmaceutical companies, and equipment manufacturers charge just as insurance companies do now. This payer could be either the state or the federal government. Every industrialized country in the world, other than the U.S., has some form of nationally administered health coverage. Medicare is a single-payer system that has been in place in the U.S. since 1966. However, Medicare is a less than ideal single-payer system because it cannot set budgets for hospitals nor negotiate prices with pharmaceutical companies.

2) Is single payer socialized medicine?

Single payer is not socialized medicine because hospitals and clinics would still be privately owned, rather than owned by the government, and doctors would still be in private practice. “Single payer” simply refers to the taking in and paying out of the health care dollars, which would replace the current multiple-payer system dominated by private insurance companies. Single payer refers to the mechanism used to pay for health care services not how the services are delivered. Many industrialized countries have a single-payer system; some provide services through a national health service, but most provide services through physicians in private practice. All of the leading single-payer bills introduced in the U.S. at the federal and state level would leave the health care provider sector in the hands of private practitioners.

3) Doesn’t Medicare have big problems?

Traditional Medicare has worked very well for patients and they have been happy with it. Because the traditional Medicare program spends a lot less money on administrative functions than private-sector insurers, Medicare is the most efficient health insurance program, public or private, in America. However, the partial privatization of Medicare since the 1980s and the recent total privatization of the Medicare drug benefit have raised costs and brought prosperity to many health plans and insurance companies. Their administrative costs have created an economic burden for the program of billions of dollars per year. Subsequently, payments to doctors, the actual providers of care, have been cut.

In many ways it is the actual need for Medicare that is causing some concern. As the U.S. population ages, there will be an increase in demand for Medicare services. That means there will be an increased need for funding to provide those services. This is not a crisis but a predictable occurrence that needs to be addressed by policy makers and health care planners.

There is a need to find a way to finance that increase in services. Reducing administrative waste through a single payer would be one of the mechanisms of doing that. Funding Medicare Part B (which is the primary revenue source for the physician and drug parts of Medicare) from general revenues rather than payroll taxes would also help eliminate the illusion that somehow Medicare Part B could “go bankrupt.” Imminent bankruptcy is never a concern for government programs, like the Pentagon, which are financed by general revenues.

4) Can we afford single payer, if that means covering 47 million uninsured people?

Compared to other countries, the United States already pays enough to provide comprehensive coverage for everyone. However, coverage for everyone isn’t realized because 31 percent of our health care spending goes for administration through the patchwork of private for-profit and not-for-profit insurance companies and health plans. Potential savings from eliminating the administrative waste and marketing expenditures of insurance carriers have been estimated at $350 billion per year.

5) Won’t there be waiting lines or rationing with single payer?

A poll done in the late 1990s showed that rationing was worse in the United States than in Canada, which has a single-payer system. At that time, 12 percent of Americans said they couldn’t get necessary health care in the previous year compared to 8 percent of Canadians. In 2005, the median wait for specialists or elective surgery was four weeks. A 2007 study highlighted the fact that 37 percent of Americans reported being unable to get necessary medical care “because of cost during the past year” versus 12 percent in Canada.

The United States already rations care based on ability to pay and 18,000 Americans die every year because they lack health insurance. Canadians live longer and are more satisfied with their health care than Americans, while paying half as much per person. If waiting problems in Canada are an issue, it’s because the health care system is underfunded rather than because it is single payer. No single-payer advocate is proposing that the United States lower health care spending to Canadian levels.

6) Won’t our aging population break the bank in a single-payer system?

Japan and European countries have a higher percentage of elderly citizens, yet they spend much less on health care than we do — and have better outcomes. Universal access to health care will improve the health of the population. The issue is what is the best way to get to that universal access in a way that is economically sustainable? A single-payer approach is the most likely approach to achieve that goal.
A single-payer system that provides universal access would also be better able to address the lifestyle and behavior issues, like obesity and tobacco and alcohol use that are major contributors to health care costs.

7) Some people believe that their insurance is meeting their needs; why should they change?

While some people may be comfortable with their present insurance coverage, that coverage is unstable and often inadequate when it is most needed. Because our current system is tied to employment, if people change or lose jobs, their coverage and care is disrupted. Others find their coverage fails when they get sick: 75 percent of the one million Americans experiencing medical bankruptcy each year were insured when they got sick. Insurance premiums are going up every year for policies that cover less and less.

8) How would single payer be financed?

There are a variety of ways that a single-payer system could be financed. Currently, about 60 percent of our health care system is publicly financed (via our taxes), 20 percent is financed by private employers, and 20 percent is financed by individuals. With a state or national single-payer health program, that funding formula could be maintained as a way to finance universal access.

Another option would be a payroll tax on employers (approximately 7 percent) and an income tax on individuals (approximately 2 percent). The payroll tax would replace all other employer expenses for employee health care. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and any other out-of-pocket payments. For the vast majority of people, a 2 percent income tax is less than what they now pay for insurance premiums and out-of-pocket payments. This is particularly true for anyone who has had a serious illness or has a family member with a serious illness. Small employers would also benefit from this payroll tax approach since many now have to pay 25 percent or more of payroll for health insurance compared to the 8.5 percent currently paid by large employers.
While most people and businesses would pay less with a single-payer approach, everyone would have more comprehensive coverage. In addition to medical care and drugs, benefits would include mental health care, dental care, and long-term care.

9) Who would run a single-payer plan?

It is a myth that with national health insurance the government will be making the medical decisions. The government would only be the administrator of the health care funds. In a publicly financed, universal health care system, medical decisions are left to the patient and doctor. Cost containment measures like negotiating limits on what providers, pharmaceutical companies, and equipment manufacturers could charge would be publicly managed by an elected and appointed body. This body, in consultation with medical experts in all fields of medicine, would decide on the benefit package, negotiate doctor fees and hospital budgets, and be responsible for health planning and the distribution of expensive technology. Right now, insurance companies make many health care decisions behind closed doors. Their primary interest is in profits, not the health of the people.

10) Won’t doctors dislike a single-payer system?

Because of its administrative burdens and the hurdles to care created by insurance companies, most physicians are very dissatisfied with the current health care system. Physicians would like to make medical decisions with their patients, without the intrusion of profit-motivated insurance companies. In addition, when patients are unable to pay because they are uninsured or underinsured, doctors often provide care for which they don’t get reimbursed. More and more physician groups are also supporting single payer.

In 2007, almost 60 percent of physicians supported government legislation to establish National Health Insurance — a 10 percent increase in support since 2002. This level of support is similar to that found among physicians in Minnesota and Massachusetts where two-thirds of physicians support single payer. This increase in support for National Health Insurance is distributed across every medical specialty. The largest increase was seen among physicians who “strongly support” National Health Insurance; now almost twice as many physicians support it as oppose it. It has been reported that the number of physicians currently supporting National Health Insurance is much larger than the entire membership of the American Medical Association.

In addition to individual physicians, a single-payer approach is supported by multiple professional organizations like the American College of Physicians, the American Medical Student Association, the National Medical Association, the American Public Health Association, and the American Nurses Association to name just a few.

11) How would we get to a single-payer system?

There are multiple paths to achieving a single-payer system. The most logical would be to develop an expanded and improved “Medicare for all” approach at the national level. National single-payer legislation (HR676) has been introduced and has more supporters than any other proposal for health care reform.

While a full-scale conversion seems unlikely in the short-term, there are steps that could move the country and states in that direction. One approach at the national level would be to add children to Medicare followed by adults. In Minnesota, single-payer legislation could be adopted for children with adults gradually added. Another Minnesota option would be to open MinnesotaCare to small employers and individuals and then expand it to large employers.

Single-payer legislation for Minnesota (SF2324) has been introduced in the Minnesota legislature by Senator John Marty and has garnered a great deal of support. In Canada, single-payer health legislation was introduced province by province, rather than at the national level which gives credence to this state-based approach as a way of moving toward a national single-payer system in the U.S.

Support for single-payer health care is increasing as people learn about the benefits of this solution for our ill-conceived health care system.

Edward P. Ehlinger, M.D., MSPH is the director of Boynton Health Service in Minneapolis, MN. Susanne L. King, M.D. is a child and adolescent psychiatrist in Lenox, Massachusetts.

Reprinted with permission, MetroDoctors, the Journal of the East Metro and West Metro Medical Societies, July/August 2008.

International Resources

Thanks to Joel A. Harrison, Ph.D., MPH for compiling the list of links below.

International Links

  • European Observatory on Health Care Systems This is a phenomenal asset. Using a set format to allow comparisons between countries, each report is about 150 pages including history, legislation, organization, delivery, financing, process and outcomes, current problems and future trends. Shorter summaries for each of the countries are also available. In addition, they have specific reports on a number of topics, including international comparisons of efforts to improve quality, etc.

International Comparisons — Process, Outcomes, Costs

The Commonwealth Fund Commission on a High Performance Health System. Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008. New York, July 2008. [based on both national and international benchmarks, this study covers topics such as quality, access, outcomes, cost, and timeliness. We often here about wait times in other countries without a compared to what? This study found that in a ranking of 6 nations, the U.S. ranked last on “ability to see doctor same/next day when sick or need medical care,” and “[getting] care after hours without going to the emergency room.]
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=692682

Nolte E, McKee M. Measuring the health of nations: analysis of mortality amenable to health care. BMJ 2003; 327: 1129-33. http://www.bmj.com/cgi/content/full/327/7424/1129

Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Affairs 2008; 27(1): 58-71
https://pnhp.org/PDF_files/Measuring%20the%20Health%20of%20Nations%20-%20Updating%20An%20Earlier%20Analysis.pdf

Gusmano MK, et al. A New Way to Compare Health Systems: Avoidable Hospital Conditions in Manhattan and Paris. Health Affairs. 2006; 25(2): 510-520. https://pnhp.org/PDF_files/A%20New%20Way%20to%20Compare%20Healh%20Systems%20-%20Avoidable.pdf

Links by Country

Multiple Countries Summaries & Additional Sources

Australia

Belgium

Canada

Denmark

Finland

France

Books & Monographs

Articles

  • Rodwin VG. The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States. American Journal of Public Health. 2003; 93(1): 31-37. http://www.ajph.org/cgi/content/full/93/1/31

Germany

New Zealand

Norway

Spain

Sweden

  • Glenngård AH, Hjalte F, Svensson M, Anell A, Bankauskaite V.
    Health Systems in Transition: Sweden. Copenhagen, DK: WHO Regional
    Office for Europe on behalf of the European Observatory on Health
    Systems and Policies, 2005. http://www.euro.who.int/Document/E88669.pdf
  • Rae D. Getting Better Value for Money from Sweden’s Healthcare System. Economics Department Working Papers No. 443. Paris, FR: OECD.
    http://www.olis.oecd.org/olis/2005doc.nsf/LinkTo/NT000040B2/$FILE/JT00189812.PDF
    This OECD document “Getting Better Value . . .” is quite good. One flaw is its discussion of the one for-profit hospital in Stockholm. While it is true that this particular hospital provides quality care at a low cost, it has to. In an environment hostile to for-profit medicine, one lone hospital has to mind its Ps and Qs or their charter would be revoked. Once the system becomes dominated by the for-profit industry, it’s an entirely different ballgame, as we know from the U.S. experience. Research shows that private, investor-owned hospitals have higher costs and higher mortality rates than private, non-profit hospitals in the U.S. The author of the document doesn’t take this into account.

Switzerland

Taiwan

United Kingdom

MedPoint and IntelliScript – harmful additions to the administrative excesses

They Know What’s in Your Medicine Cabinet

by Chad Terhune
BusinessWeek
July 23,2008
That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.
An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.
Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group , Aetna (AET), Blue Cross plans, and other insurance giants have ready access to applicants’ prescription histories.
An investigation last year by the Federal Trade Commission found that the two companies supplying these pharmacy profiles—MedPoint and IntelliScript—violated federal law for years by keeping the system hidden from consumers. But the FTC has merely required disclosure if prescription information causes denial of coverage or some other adverse action; the agency imposed no penalties.
MedPoint and IntelliScript buy the data they disseminate mostly from another group of middleman companies known as pharmacy-benefit managers (PBMs). Large PBMs, such as Medco Health Solutions, provide services to insurers and employers. In playing that role, the PBMs gain broad access to prescription information from drugstores.
http://www.businessweek.com/print/magazine/content/08_31/b4094000643943.htm

MedPoint and IntelliScript represent the type of administrative services that the private insurance industry is selling us. These services are not for the purpose of assisting individuals in gaining access to the health care that they need. These services are for the purpose of allowing the insurance industry to exclude from their plans anyone who might actually need health care. And we’re paying more in administrative costs to defeat this risk pooling function of insurance.
Some say that all we have to do is to increase regulatory oversight of this industry in order to use private insurance as the framework of comprehensive reform. The problem with this reasoning is that business model of private insurers in the United States has nothing in common with the model of private insurers used in some other nations with comprehensive systems. Other nations use private plans to bring everyone in under the umbrella of insurance coverage. We use private plans to keep premiums affordable while shoving those who need health care out into the storm to either fend on their own or to be picked up by taxpayer-financed safety net programs.
We will not achieve our goal of universal health care merely by increasing regulatory oversight of the insurers. We will have to totally transform the private insurance industry from a “successful” business model where success is measured by not paying for health care that people need, to a public service model where success is measured by seeing that all of us get the care we need.
Rather than disassembling these companies and rebuilding them as new private insurance entities within a social insurance system, it would be far easier, more efficient, more equitable and less expensive to dismiss them and replace them with our own publicly-financed and publicly-administered program.
If we leave them in place and merely increase regulation, their business model will dictate that they must introduce yet more innovations that circumvent regulation for the purpose of enhancing their business outcomes while shifting more of the responsibility of financing health care to the taxpayers. We can’t afford it any more. We need an efficient system that actually gets people the health care that they need.

MedPoint and IntelliScript – harmful additions to the administrative excesses

They Know What's in Your Medicine Cabinet

by Chad Terhune
BusinessWeek
July 23,2008

That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.
Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group , Aetna (AET), Blue Cross plans, and other insurance giants have ready access to applicants’ prescription histories.

An investigation last year by the Federal Trade Commission found that the two companies supplying these pharmacy profiles–MedPoint and IntelliScript–violated federal law for years by keeping the system hidden from consumers. But the FTC has merely required disclosure if prescription information causes denial of coverage or some other adverse action; the agency imposed no penalties.

MedPoint and IntelliScript buy the data they disseminate mostly from another group of middleman companies known as pharmacy-benefit managers (PBMs). Large PBMs, such as Medco Health Solutions, provide services to insurers and employers. In playing that role, the PBMs gain broad access to prescription information from drugstores.

http://www.businessweek.com/print/magazine/content/08_31/b4094000643943.htm

Comment:

By Don McCanne, MD

MedPoint and IntelliScript represent the type of administrative services that the private insurance industry is selling us. These services are not for the purpose of assisting individuals in gaining access to the health care that they need. These services are for the purpose of allowing the insurance industry to exclude from their plans anyone who might actually need health care. And we’re paying more in administrative costs to defeat this risk pooling function of insurance.

Some say that all we have to do is to increase regulatory oversight of this industry in order to use private insurance as the framework of comprehensive reform. The problem with this reasoning is that business model of private insurers in the United States has nothing in common with the model of private insurers used in some other nations with comprehensive systems. Other nations use private plans to bring everyone in under the umbrella of insurance coverage. We use private plans to keep premiums affordable while shoving those who need health care out into the storm to either fend on their own or to be picked up by taxpayer-financed safety net programs.

We will not achieve our goal of universal health care merely by increasing regulatory oversight of the insurers. We will have to totally transform the private insurance industry from a “successful” business model where success is measured by not paying for health care that people need, to a public service model where success is measured by seeing that all of us get the care we need.

Rather than disassembling these companies and rebuilding them as new private insurance entities within a social insurance system, it would be far easier, more efficient, more equitable and less expensive to dismiss them and replace them with our own publicly-financed and publicly-administered program.

If we leave them in place and merely increase regulation, their business model will dictate that they must introduce yet more innovations that circumvent regulation for the purpose of enhancing their business outcomes while shifting more of the responsibility of financing health care to the taxpayers. We can’t afford it any more. We need an efficient system that actually gets people the health care that they need.

They Know What's in Your Medicine Cabinet

How insurance companies dig up applicants’ prescriptions–and use them to deny coverage

by Chad Terhune
Business Week
July 23, 2008

That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.

Privacy and consumer advocates warn that the information can easily be misinterpreted or knowingly misused. At a minimum, the practice is adding another layer of anxiety to a marketplace that many consumers already find baffling. “It’s making it harder to find insurance for people,” says Jay Horowitz, an independent insurance agent in Overland Park, Kan.

The obstacle primarily confronts people seeking individual health insurance, not those covered under an employer’s plan. Walter and Paula Shelton of Gilbert, La., applied to Humana (HUM) in February. They were rejected by the large Louisville insurer after a company representative pulled their drug profiles and questioned them over the telephone about prescriptions from Wal-Mart Stores (WMT) and Randalls, part of the Safeway grocery chain, for blood-pressure and anti-depressant medications.

Mental Health Is a Red Flag

Walter Shelton, a 57-year-old safety consultant in the oil and gas industry, says he tried to explain that the medications weren’t for serious ailments. The blood-pressure prescription related to a minor problem his wife, Paula, had with swelling of her ankles. The antidepressant was prescribed to help her sleep–a common “off-label” treatment doctors advise for some menopausal women. But drugs for depression and other mental health conditions are often red flags to insurers.

Despite his efforts to reassure Humana, the phone interview with the company representative “just went south,” Walter recounts. He and his wife remain uninsured.

“I want to know what’s in there if there’s a black mark against us,” Walter says. Paula, 51, adds: “We can’t get health insurance because we’re taking medications that were prescribed by our doctors. I don’t think that’s right.”

A spokesman for Humana says the company uses “data regarding pharmacy history as part of our assessment process.” But he adds that the insurer has a policy of not commenting on particular cases, such as the Sheltons’ failed application.

FTC Investigation

Traditionally, applicants have been asked to provide insurers with a description of past illnesses. About 30% are deemed uninsurable because of their histories, according to industry veterans. Prescription profiles could add another hurdle, making it especially difficult for the 47 million Americans who lack insurance to acquire coverage. Some 18 million people are now covered by individual policies.

Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group , Aetna (AET), Blue Cross plans, and other insurance giants have ready access to applicants’ prescription histories. These online reports, available in seconds from a pair of little-known intermediary companies at a cost of only about $15 per search, typically include voluminous information going back five years on dosage, refills, and possible medical conditions. The reports also provide a numerical score predicting what a person may cost an insurer in the future.

An investigation last year by the Federal Trade Commission found that the two companies supplying these pharmacy profiles–MedPoint and IntelliScript–violated federal law for years by keeping the system hidden from consumers. But the FTC has merely required disclosure if prescription information causes denial of coverage or some other adverse action; the agency imposed no penalties. MedPoint and IntelliScript say they are now fully complying with the FTC’s order.

Two-thirds of all health insurers are using prescription data–not only to deny coverage to individuals and families but also to charge some customers higher premiums or exclude certain medical conditions from policies, according to agents and others in the industry. Some carriers are also using the data to charge small employers higher group rates. Separately, some 20% of life insurance companies are relying on prescription histories when reviewing applications, according to experts in that business.

Designed for Emergency Use

“The fundamental breakthrough is that this is the first time ever we have had near-instantaneous access to objective, third-party information,” says Tia Goss Sawhney, an actuary and consultant to the health insurance industry. She says she tested the prescription profiles last year while designing a new insurance policy for American Community Mutual Insurance in Livonia, Mich.

IntelliScript says it sells prescription data to more than 75 health, life, and long-term-care insurance companies. Milliman, a large Seattle consulting firm, acquired the company in 2005. A rival service, MedPoint, has been offered by UnitedHealth’s Ingenix data-mining unit since 2002. MedPoint says it has access to more than 5 billion pharmacy claims.

The data were originally sought to help inform doctors treating patients, especially in emergencies. But that use hasn’t widely caught on, and today the information is primarily employed by insurance companies.

MedPoint and IntelliScript buy the data they disseminate mostly from another group of middleman companies known as pharmacy-benefit managers (PBMs). Large PBMs, such as Medco Health Solutions, provide services to insurers and employers. In playing that role, the PBMs gain broad access to prescription information from drugstores. Some retail chains operate their own PBMs. No privacy laws or other regulations prevent the gathering of this data, according to the FTC.

Fodder for Denials

In its marketing to the insurance industry, MedPoint says prescription histories help “identify high-risk individuals, reduce costs, lower loss ratios, and increase revenue.” Despite that pitch, John Stenson, an Ingenix executive who helps oversee MedPoint, says he doubts that his company’s information causes insurers systematically to reject more people for coverage. “This is about insurance companies getting at the information quickly and clearly,” he says.

BlueCross BlueShield of Tennessee, the state’s biggest insurer, has used MedPoint since April 2007, ordering prescription profiles for about 75% of individual applicants. Since February, when the federal disclosure requirement went into effect, BlueCross says it has notified 1.5% of applicants that their prescription reports have resulted in denial or other negative action. But the company acknowledges that it doesn’t alert consumers if the profiles lead to requests for more medical information that result in subsequent denial. “This doesn’t make it any harder for consumers,” Kevin Ashpole, director of individual products at Tennessee BCBS, maintains. “It ensures the right decision is made.”

But skeptics worry that more people inevitably will be turned down for coverage as a result of growing reliance on prescription histories. Most consumers would be shocked to learn that information about their past prescriptions is being bought and sold–and could come back to haunt them, says Gary Claxton, director of the Health Care Marketplace Project, a research organization run by the Kaiser Family Foundation in Washington, D.C. Rejection by one insurer commonly becomes grounds for denial by others, and the industry has ready access to who has been turned down through a separate database.

Is Disclosure Enough?

When applying for insurance, individuals routinely sign paperwork allowing providers to review their medical history. To comply with the privacy provisions of the federal Health Insurance Portability & Accountability Act, most insurers have now added a reference to prescription history in the lengthy fine print consumers are instructed to read.

The FTC forced the industry to begin disclosing the use of prescription information under a different federal statute, the Fair Credit Reporting Act. Insurers now are required to tell applicants the address of the company that assembled the data. Copies of prescription reports are supposed to be available to consumers at no charge under federal law.

“As soon as we were alerted by the FTC, we cooperated fully, and we began sending out notices to [insurance industry] clients of their obligations” under federal law, says Mark Franzen, managing director of IntelliScript. “This wasn’t the result of a consumer complaint or privacy being violated.” The FTC confirms that its investigation didn’t stem from consumer concern but won’t say what did spark the inquiry.

Insurance companies say that they use prescription data responsibly and that it isn’t the sole basis of decisions to deny coverage. A spokesman for UnitedHealth (UNH) adds that when there are discrepancies between the data and information provided directly by applicants, “the applicant is contacted and given the opportunity to provide additional information.”

But privacy watchdogs and some insurance agents question how insurance carriers can guarantee that they are obtaining accurate prescription histories, especially for people with highly common names. The skeptics also worry about whether legitimate off-label use of prescription drugs by patients such as Paula Shelton could hurt some applicants unfairly.

IntelliScript’s Franzen says it’s the responsibility of the insurance company to deal with issues such as off-label use. He says IntelliScript has reported the wrong person’s drug file in several instances but that mistakes occur in fewer than 1 in 10,000 cases. MedPoint says it has had only “two cases of matching errors in more than 2 million queries.” Most searches include full name, date of birth, Social Security number, and address.

“Is it perfect? No,” Franzen says. “But it’s pretty darn good.”

Julius Richmond, surgeon general under Carter, dies

Note from PNHP: Dr. Richmond was an ardent supporter of single payer national health insurance

By Bryan Marquard
Globe Staff
July 29, 2008 06:34 PM

Poverty undercuts the ability of the young to learn, Dr. Julius B. Richmond realized during research half a century ago, and he drew from his findings to launch Project Head Start, a federal program that has helped millions of children since its inception in 1965.

“It really is a remarkable legacy to his career, how many graduates of Head Start programs there are all over the country who have benefited from early childhood care and education,” said Allan Brandt, dean of the Graduate School of Arts and Sciences at Harvard University.

Dr. Richmond, who also served as US surgeon general under President Jimmy Carter, died in his Chestnut Hill home Sunday. He was 91 and as recently as May was still spending a few hours each day in his office at Harvard, where was a professor emeritus, despite having been diagnosed with cancer a couple of years ago.

“Jimmy and I are saddened to learn of the loss of our dear friend and colleague Dr. Julius Richmond,” Rosalynn Carter, the former first lady, said in a statement issued today. “Julie was a wonderful and compassionate champion in the fight to improve health, mental health, and educational opportunities for our nation’s children. All Americans have benefited from his decades of leadership in advancing the health care needs of our country.”

In a career that ranged from serving as a flight surgeon in the Army Air Corps during World War II to serving as surgeon general from 1977 to 1981, Dr. Richmond left few areas of medicine untouched.

Even at 90, Dr. Richmond was weighing in on national medical issues, decrying the lack of universal health coverage.

“The financiers don’t want government intervention,” Dr. Richmond told the Globe in October 2006. “It’s such an embarrassment that I think the issue will resurface, but it’s difficult for the political figures in Washington to formulate a plan.”

The intersection of public need, political will, and public policy was something Dr. Richmond thought about frequently.

“He often used three variables to describe the most significant elements of public policy,” Brandt said. “He would ask, ‘Do we know enough, what’s the knowledge base?’ Then he would ask, ‘Is there the political will to apply what we know?’ Then he would ask, ‘Do we have a social strategy to bring the knowledge and the politics together in a productive way?’ He was a great analytic thinker and was always thinking about what we need to do to improve a particular situation.”

The family plans to hold a private service and Harvard will announce a public memorial service.

Can't Get No Health Care Satisfaction

by Pat LaMarche
Bangor Daily News
Wednesday, July 30, 2008

A Fox News anchor said Saturday that if Mick Jagger was from the United States he’d finally qualify for Medicare.

She’s kidding — right?

The anchor made a pretty lame attempt at highlighting the rock star’s advancing age. She did, however, do a good job of pointing out how backward the U.S. health care system is.

See, Mick Jagger’s from the United Kingdom and he’s had universal government medical benefits since he was five. That’s because 60 years ago the United Kingdom instituted their National Health Service.

George Bernard Shaw once said that “England and America are two countries separated by a common language.” And that distinctive terminology doesn’t just lend itself to cute little linguistic differences like how they say “lorry” when we say “truck.”

There is also the language used in the U.S. that doesn’t have corresponding lingo in the UK. One example of jargon unique to the U.S. is the term “redlining.” In the U.S., redlining is when an insurance company denies you health care coverage because of a pre-existing condition. In the UK, redlining doesn’t exist.

In fact, according to Health Affairs, “the number one cited health policy journal devoted to publishing original, peer-reviewed research and commentary,” medical redlining is quantified as the “denial rate among applicants for non-group coverage.” Health Affairs lists conditions frequently redlined and the rates at which people are denied access to further coverage. Two of the patient subsets most commonly redlined are breast cancer survivors, 43 percent of the time and HIV patients 100 percent of the time.

There’s a neat organization in the world. It’s called the Organization for Economic Co-operation and Development, OECD. The group consists of 30 member countries that embrace the notion of “democracy” and support a “free market” economy. It used to be called the Organization for European Economic Cooperation and it began as a result of the Marshall Plan – America’s effort to rebuild Europe after World War II. The OECD compiles statistics: Statistics that illuminate the economic conditions and comparatives among their representative democracies.

OECD statistics state that in 2003, the per capita out-of-pocket expenses for healthcare in the U.S. were $722; while in the UK they were only $208.

The Brits aren’t just saving money, they’re living longer. Again, according to OECD, folks in the UK live about 11 months longer than folks in the U.S. This means that in Mick Jagger’s lifetime, with numbers extrapolated for inflation, the average resident of the UK would have saved somewhere around $30,000 over their U.S. counterpart. Think of it as money they could use to live on during that extra year of life.

But that’s just the difference in out-of-pocket expenses. Out-of-pocket costs are nothing compared with a nation’s overall medical expenses. Here the numbers get really staggering.

Again, according to the same smart data-gathering agency that we created under the Marshall Plan, the 2005 per capita cost for health care in the U.S. was $5,290 while in the UK it was only $2,230. That’s $3,060 per person per year. Over the course of a lifetime that sort of money adds up. In simple terms it means that Mick Jagger’s lifetime health needs will cost his society about $180,000 less then our own John Mellencamp will cost us.

All together, between out-of-pocket and regular health expenditures, some London rocker’s health care is almost a quarter of a million dollars cheaper — again adjusted for inflation — than our rock star from Seymour, Ind.

But those expenses are national averages. Ordinary people aren’t as capable of making up the difference as rock stars are. Statistics show that middle income folks still chip in their share of health care costs but go without needed services.

According to a 2002 survey of U.S. taxpayers earning between $25,000 and $50,000 per year conducted by National Public Radio, the Kaiser Family Foundation and Harvard’s Kennedy School of Government, 22 percent of middle class Americans postponed receiving care. Twenty-three percent had problems paying for the care they did receive and 13 percent did not get necessary drug prescriptions filled.

Remember Mick Jagger singing, “Mother’s little helper?” In the U.S. it isn’t just a “drag” getting old — it’s also a little less likely and enormously more expensive.

Pat LaMarche of Yarmouth is the spokesperson for the Evergreen Mountain Resort & Casino referendum campaign. She’s the author of “Left Out in America” and may be reached at PatLaMarche@hotmail.com.

They Know What’s in Your Medicine Cabinet

How insurance companies dig up applicants’ prescriptions–and use them to deny coverage

by Chad Terhune
Business Week
July 23, 2008

That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.

Privacy and consumer advocates warn that the information can easily be misinterpreted or knowingly misused. At a minimum, the practice is adding another layer of anxiety to a marketplace that many consumers already find baffling. “It’s making it harder to find insurance for people,” says Jay Horowitz, an independent insurance agent in Overland Park, Kan.

The obstacle primarily confronts people seeking individual health insurance, not those covered under an employer’s plan. Walter and Paula Shelton of Gilbert, La., applied to Humana (HUM) in February. They were rejected by the large Louisville insurer after a company representative pulled their drug profiles and questioned them over the telephone about prescriptions from Wal-Mart Stores (WMT) and Randalls, part of the Safeway grocery chain, for blood-pressure and anti-depressant medications.

Mental Health Is a Red Flag

Walter Shelton, a 57-year-old safety consultant in the oil and gas industry, says he tried to explain that the medications weren’t for serious ailments. The blood-pressure prescription related to a minor problem his wife, Paula, had with swelling of her ankles. The antidepressant was prescribed to help her sleep–a common “off-label” treatment doctors advise for some menopausal women. But drugs for depression and other mental health conditions are often red flags to insurers.

Despite his efforts to reassure Humana, the phone interview with the company representative “just went south,” Walter recounts. He and his wife remain uninsured.

“I want to know what’s in there if there’s a black mark against us,” Walter says. Paula, 51, adds: “We can’t get health insurance because we’re taking medications that were prescribed by our doctors. I don’t think that’s right.”

A spokesman for Humana says the company uses “data regarding pharmacy history as part of our assessment process.” But he adds that the insurer has a policy of not commenting on particular cases, such as the Sheltons’ failed application.

FTC Investigation

Traditionally, applicants have been asked to provide insurers with a description of past illnesses. About 30% are deemed uninsurable because of their histories, according to industry veterans. Prescription profiles could add another hurdle, making it especially difficult for the 47 million Americans who lack insurance to acquire coverage. Some 18 million people are now covered by individual policies.

Most consumers and even many insurance agents are unaware that Humana, UnitedHealth Group , Aetna (AET), Blue Cross plans, and other insurance giants have ready access to applicants’ prescription histories. These online reports, available in seconds from a pair of little-known intermediary companies at a cost of only about $15 per search, typically include voluminous information going back five years on dosage, refills, and possible medical conditions. The reports also provide a numerical score predicting what a person may cost an insurer in the future.

An investigation last year by the Federal Trade Commission found that the two companies supplying these pharmacy profiles–MedPoint and IntelliScript–violated federal law for years by keeping the system hidden from consumers. But the FTC has merely required disclosure if prescription information causes denial of coverage or some other adverse action; the agency imposed no penalties. MedPoint and IntelliScript say they are now fully complying with the FTC’s order.

Two-thirds of all health insurers are using prescription data–not only to deny coverage to individuals and families but also to charge some customers higher premiums or exclude certain medical conditions from policies, according to agents and others in the industry. Some carriers are also using the data to charge small employers higher group rates. Separately, some 20% of life insurance companies are relying on prescription histories when reviewing applications, according to experts in that business.

Designed for Emergency Use

“The fundamental breakthrough is that this is the first time ever we have had near-instantaneous access to objective, third-party information,” says Tia Goss Sawhney, an actuary and consultant to the health insurance industry. She says she tested the prescription profiles last year while designing a new insurance policy for American Community Mutual Insurance in Livonia, Mich.

IntelliScript says it sells prescription data to more than 75 health, life, and long-term-care insurance companies. Milliman, a large Seattle consulting firm, acquired the company in 2005. A rival service, MedPoint, has been offered by UnitedHealth’s Ingenix data-mining unit since 2002. MedPoint says it has access to more than 5 billion pharmacy claims.

The data were originally sought to help inform doctors treating patients, especially in emergencies. But that use hasn’t widely caught on, and today the information is primarily employed by insurance companies.

MedPoint and IntelliScript buy the data they disseminate mostly from another group of middleman companies known as pharmacy-benefit managers (PBMs). Large PBMs, such as Medco Health Solutions, provide services to insurers and employers. In playing that role, the PBMs gain broad access to prescription information from drugstores. Some retail chains operate their own PBMs. No privacy laws or other regulations prevent the gathering of this data, according to the FTC.

Fodder for Denials

In its marketing to the insurance industry, MedPoint says prescription histories help “identify high-risk individuals, reduce costs, lower loss ratios, and increase revenue.” Despite that pitch, John Stenson, an Ingenix executive who helps oversee MedPoint, says he doubts that his company’s information causes insurers systematically to reject more people for coverage. “This is about insurance companies getting at the information quickly and clearly,” he says.

BlueCross BlueShield of Tennessee, the state’s biggest insurer, has used MedPoint since April 2007, ordering prescription profiles for about 75% of individual applicants. Since February, when the federal disclosure requirement went into effect, BlueCross says it has notified 1.5% of applicants that their prescription reports have resulted in denial or other negative action. But the company acknowledges that it doesn’t alert consumers if the profiles lead to requests for more medical information that result in subsequent denial. “This doesn’t make it any harder for consumers,” Kevin Ashpole, director of individual products at Tennessee BCBS, maintains. “It ensures the right decision is made.”

But skeptics worry that more people inevitably will be turned down for coverage as a result of growing reliance on prescription histories. Most consumers would be shocked to learn that information about their past prescriptions is being bought and sold–and could come back to haunt them, says Gary Claxton, director of the Health Care Marketplace Project, a research organization run by the Kaiser Family Foundation in Washington, D.C. Rejection by one insurer commonly becomes grounds for denial by others, and the industry has ready access to who has been turned down through a separate database.

Is Disclosure Enough?

When applying for insurance, individuals routinely sign paperwork allowing providers to review their medical history. To comply with the privacy provisions of the federal Health Insurance Portability & Accountability Act, most insurers have now added a reference to prescription history in the lengthy fine print consumers are instructed to read.

The FTC forced the industry to begin disclosing the use of prescription information under a different federal statute, the Fair Credit Reporting Act. Insurers now are required to tell applicants the address of the company that assembled the data. Copies of prescription reports are supposed to be available to consumers at no charge under federal law.

“As soon as we were alerted by the FTC, we cooperated fully, and we began sending out notices to [insurance industry] clients of their obligations” under federal law, says Mark Franzen, managing director of IntelliScript. “This wasn’t the result of a consumer complaint or privacy being violated.” The FTC confirms that its investigation didn’t stem from consumer concern but won’t say what did spark the inquiry.

Insurance companies say that they use prescription data responsibly and that it isn’t the sole basis of decisions to deny coverage. A spokesman for UnitedHealth (UNH) adds that when there are discrepancies between the data and information provided directly by applicants, “the applicant is contacted and given the opportunity to provide additional information.”

But privacy watchdogs and some insurance agents question how insurance carriers can guarantee that they are obtaining accurate prescription histories, especially for people with highly common names. The skeptics also worry about whether legitimate off-label use of prescription drugs by patients such as Paula Shelton could hurt some applicants unfairly.

IntelliScript’s Franzen says it’s the responsibility of the insurance company to deal with issues such as off-label use. He says IntelliScript has reported the wrong person’s drug file in several instances but that mistakes occur in fewer than 1 in 10,000 cases. MedPoint says it has had only “two cases of matching errors in more than 2 million queries.” Most searches include full name, date of birth, Social Security number, and address.

“Is it perfect? No,” Franzen says. “But it’s pretty darn good.”

Can’t Get No Health Care Satisfaction

by Pat LaMarche
Bangor Daily News
Wednesday, July 30, 2008

A Fox News anchor said Saturday that if Mick Jagger was from the United States he’d finally qualify for Medicare.

She’s kidding — right?

The anchor made a pretty lame attempt at highlighting the rock star’s advancing age. She did, however, do a good job of pointing out how backward the U.S. health care system is.

See, Mick Jagger’s from the United Kingdom and he’s had universal government medical benefits since he was five. That’s because 60 years ago the United Kingdom instituted their National Health Service.

George Bernard Shaw once said that “England and America are two countries separated by a common language.” And that distinctive terminology doesn’t just lend itself to cute little linguistic differences like how they say “lorry” when we say “truck.”

There is also the language used in the U.S. that doesn’t have corresponding lingo in the UK. One example of jargon unique to the U.S. is the term “redlining.” In the U.S., redlining is when an insurance company denies you health care coverage because of a pre-existing condition. In the UK, redlining doesn’t exist.

In fact, according to Health Affairs, “the number one cited health policy journal devoted to publishing original, peer-reviewed research and commentary,” medical redlining is quantified as the “denial rate among applicants for non-group coverage.” Health Affairs lists conditions frequently redlined and the rates at which people are denied access to further coverage. Two of the patient subsets most commonly redlined are breast cancer survivors, 43 percent of the time and HIV patients 100 percent of the time.

There’s a neat organization in the world. It’s called the Organization for Economic Co-operation and Development, OECD. The group consists of 30 member countries that embrace the notion of “democracy” and support a “free market” economy. It used to be called the Organization for European Economic Cooperation and it began as a result of the Marshall Plan – America’s effort to rebuild Europe after World War II. The OECD compiles statistics: Statistics that illuminate the economic conditions and comparatives among their representative democracies.

OECD statistics state that in 2003, the per capita out-of-pocket expenses for healthcare in the U.S. were $722; while in the UK they were only $208.

The Brits aren’t just saving money, they’re living longer. Again, according to OECD, folks in the UK live about 11 months longer than folks in the U.S. This means that in Mick Jagger’s lifetime, with numbers extrapolated for inflation, the average resident of the UK would have saved somewhere around $30,000 over their U.S. counterpart. Think of it as money they could use to live on during that extra year of life.

But that’s just the difference in out-of-pocket expenses. Out-of-pocket costs are nothing compared with a nation’s overall medical expenses. Here the numbers get really staggering.

Again, according to the same smart data-gathering agency that we created under the Marshall Plan, the 2005 per capita cost for health care in the U.S. was $5,290 while in the UK it was only $2,230. That’s $3,060 per person per year. Over the course of a lifetime that sort of money adds up. In simple terms it means that Mick Jagger’s lifetime health needs will cost his society about $180,000 less then our own John Mellencamp will cost us.

All together, between out-of-pocket and regular health expenditures, some London rocker’s health care is almost a quarter of a million dollars cheaper — again adjusted for inflation — than our rock star from Seymour, Ind.

But those expenses are national averages. Ordinary people aren’t as capable of making up the difference as rock stars are. Statistics show that middle income folks still chip in their share of health care costs but go without needed services.

According to a 2002 survey of U.S. taxpayers earning between $25,000 and $50,000 per year conducted by National Public Radio, the Kaiser Family Foundation and Harvard’s Kennedy School of Government, 22 percent of middle class Americans postponed receiving care. Twenty-three percent had problems paying for the care they did receive and 13 percent did not get necessary drug prescriptions filled.

Remember Mick Jagger singing, “Mother’s little helper?” In the U.S. it isn’t just a “drag” getting old — it’s also a little less likely and enormously more expensive.

Pat LaMarche of Yarmouth is the spokesperson for the Evergreen Mountain Resort & Casino referendum campaign. She’s the author of “Left Out in America” and may be reached at PatLaMarche@hotmail.com.

Will America enact national health insurance in 2009?

A video editorial by Dr. Quentin Young, Physicians for a National Health Program

Transcript of Dr. Young’s remarks:

By Quentin Young

The 43rd anniversary of the passage of Medicare is an appropriate time to examine just why this single-payer government-run national health insurance has not been expanded to everybody. Despite its deficiencies, Medicare serves the elderly remarkably better than the confusion of for-profit private insurance schemes that have steadily disserved the American patient.

Of course, the failure to have fundamental health care reform has been the result of the awesome power of the industry, which profits from the present arrangements — big pharma, for-profit hospitals, and health insurance giants. In addition to the increasingly frustrated “beneficiaries,” America’s physicians have suffered under the health system organized to assure returns to investors.

Doctors have, at long last, realized that there is something worse than government: corporate-run health care.

Heretofore the prevailing political and health policy wisdom has been that expansion of Medicare to everybody was simply politically unfeasible. Billions of dollars are ready to be spent resisting health reform; recall “Harry and Louise” in 1993.

Recent months have seen a huge shift in public positions on single-payer health care. In a recent AP poll, 65 percent of the public agreed that the United States should “adopt a universal health insurance program … like Medicare that is run by the government and financed by taxpayers.” In January, the American College of Physicians endorsed single payer for the first time as a pathway to universal coverage. In April, the Annals of Internal Medicine published a national survey of physicians indicating that 59 percent of doctors support the adoption of legislation to create national health insurance.

Significantly, on June 23, the U.S. Conference of Mayors, representing cities of over 30,000 people, unanimously endorsed legislation for Medicare for All, H.R. 676.

Could 2009 turn out to be the year this nation takes the leap to enact a national health system?

That’s my opinion. I’m Dr. Quentin Young, national coordinator, Physicians for a National Health Program.

Happy Birthday Medicare

By Judy Deutsch
Guest Columnist
Sudbury Town Crier
July 23, 2008

July 30th will be Medicare’s 43rd birthday.

And many people across our nation will be celebrating the event by letting their Congressional representatives know that they want to be included, too.

They’ll do so be sending a birthday cake and/or card to their representatives saying, ” Happy Birthday Medicare: Now It’s time for Medicare for all” or “Support HR 676.”

HR 676 is the improved Medicare for all bill introduced in the House by Rep. John Conyers.

This bill provides the only way to achieve quality health care for all U.S. residents at an affordable price to the nation and to individuals.

You must know that overhead costs in the health insurance industry (and the resulting excessive paperwork for health care providers) represent 30 to 40 percent of each healthcare premium dollar, and that Medicare’s overhead costs are far less.

It is past time that our nation stopped ripping off the American people by paying so much for the marketing and advertising of health insurance policies, and for the huge salary packages of health insurance CEOs.

It is past time that our nation acknowledged that the fiduciary responsibility of the health insurance industry is to make profits for its shareholders, not provide quality care for its policy holders.

We individuals need to have a program that provides quality health care at an affordable price for all residents. Our industries need it so that they can be competitive with industries in nations where health care is not privately financed.

The enactment and implementation of H.R. 676 will provide such a program. It will improve the Medicare program that exists and expand its coverage to all U.S. residents.

We would each receive a United States Health Insurance Card and would be entitled to primary care and prevention, inpatient care, outpatient care, emergency care, prescription drugs (which will be bought in bulk at negotiated prices), durable medical equipment, long-term care, mental- health care, the full range of dental services other than cosmetic dentistry, substance-abuse treatment services, chiropractic services, basic vision care and vision correction., and hearing services including hearing aids.

We would be entitled to this care from a licensed clinician anywhere in the United States without paying deductibles, copayments, or coinsurance.

And we would pay for this care by:

* using the federal and state funds currently being used for current health programs,

* a payroll tax of 4.7 percent on all employers and employees,

* a 5 percent health tax on the top 5 percent of income earners and a 10 percent tax on the top 1 percent of income earners,

* a one tenth of 1 percent tax on stock and bond transactions

We would spend less for our health care than we do now. A family of three making $40,000 per year would spend approximately $1,600 per year for health coverage, average employers will spend less for health coverage than they do now, and Physicians for a National Health program has estimated that our nation would save over $286 billion a year in total health care costs.

The Secretary of Health and Human Services would administer this system through a director appointed by the secretary. Under the director, there would be an office of quality control which would conduct annual reviews on the adequacy of medically necessary services and would make recommendations for proposed changes to Congress, the president, and the secretary. And a National Board of Universal Quality and Access would be established to ensure quality, access and affordability.

The director would be charged with making a good-faith effort to create a uniform electronic billing system, including in those areas where electronic billing is not yet established.

Annually, there would be established: an operating budget; a capital expenditures budget, reimbursement levels for providers, and a health professional educational budget, including the continued funding of resident physician training programs. The director would provide regional offices with an annual funding allotment to cover regional global budgets, reimbursements to clinicians, and capital expenditures.

Global budgets of providers would be established through annual negotiations between providers and regional directors.

Private health care insurers would be prohibited from selling coverage that duplicates the benefits provided in this bill, but could sell coverage for additional benefits such as cosmetic surgery and private rooms. Workers displaced from their health insurance industry jobs would be eligible for retraining and first preference for jobs in the new system.

HR 676 has 90 co-sponsors in the U.S. House of Representatives. It has been endorsed by the Kentucky and New Hampshire Houses of Representatives, the New York State Assembly, and by dozens of cities and counties from Baltimore to San Francisco and from Warren County, Tennessee, to majority Republican Rensselaer County in New York.

Recently, the U.S. Conference of Mayors, representing more than 1,000 cities with populations over 30,000, unanimously adopted a resolution in support of H.R. 676. The recent General Assembly of the Presbyterian Church USA proclaimed single payer, universal national health program “the program that best responds to the moral imperative of the gospel,” and the June 2008 General Assembly of the Unitarian Universalist Association endorsed H.R. 676.

So have 34 state AFL-CIO federations, 110 central labor councils, more than 445 union organizations, and international unions.

Recent polls have shown that 59 percent of physicians nationwide now support single-payer and that 65 percent of people believe: “The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.”

To do otherwise, is to continue to undermine our nation’s health and its pocketbooks. Just how much longer do we want to spend more than twice as much as any other nation for health care and still be among the highest in infant mortality and among the lowest in longevity

Please send a birthday card to our Rep. Niki Tsongas, asking that she support improved Medicare for all, HR 676.

http://www.wickedlocal.com/sudbury/news/lifestyle/columnists/x1346890415/Deutsch-Happy-Birthday-Medicare

Uninsured left in the lurch

Thousands pour into SW Va. this weekend seeking free health care

By LOUIS LLOVIO
Richmond Times-Dispatch
Monday, Jul 28, 2008

WISE — They have come by the thousands.

They walk through the gates of the fairgrounds, give their most personal information to complete strangers and are ushered off for a battery of tests and procedures.

An expected 3,000-plus residents of Southwest Virginia and neighboring states are here through today for one reason — to get basic medical care they couldn’t otherwise afford.

A crowd began lining up in the wee hours of Friday morning for a coveted spot inside the fences at the Remote Area Medical clinic. Some would wait days for the free service. Some would never get in.

For the majority though, organizers and doctors said, this would be the only time all year they would get medical treatment of any sort.

Remote Area Medical, based in Knoxville, Tenn., has provided medical care for the poor and uninsured in the United States and around the world since 1985.

Since Friday, volunteer doctors, optometrists, pharmacists and dentists have been helping patients during 14-hour days.

Charles Sizemore, a 68-year old retired machinist from Wise County, got in line Friday about 2 a.m. for a basic physical and to get two fillings replaced.

Sizemore raised four children in the area but never had health insurance until he got Medicare when he retired three years ago.

“I wanted to,” he said, leaning against bleachers where patients were being registered as the sun rose over the mountains. “There just wasn’t enough money. I had to take care of my family, and I never made more than $10 an hour.”

All his children have left the area for better-paying jobs, but he’s too old to move, he said playfully.

Turning serious, Sizemore said, “I don’t mean to be ungrateful. I’m glad RAM comes out and does this. But it’s just damned sad that this is the only time most of the people around here are going to see a doctor. It’s a damned shame.”

Teresa Gardner said the RAM event is vitally important.

Gardner is executive director of The Health Wagon, a nonprofit organization that provides health care for the uninsured and underinsured in Southwest Virginia. It is the local organizer for the RAM event.

“The main problem is that these people don’t have access to even the most basic health care because they can’t afford it,” she said. “And those that can afford the insurance, or get it through their companies, can’t afford to pay the co-pays or the prescriptions.”

According to the figures released this year by the U.S. Department of Commerce’s Bureau of Economic Analysis, per-capita personal income in Wise County is $25,330. That’s about $14,000 less than the state average and several thousand less than in the Richmond area. The U.S. personal per capita income is $36,714.

A study by the Southwest Virginia Graduate Medical Education Consortium paints a bleak picture about health in this part of the state. In the study, Southwest Virginia is defined as the 16-locality area between and including Lee County to the west and Bland, Wythe and Carroll counties to the east.

The study found that people living in the region are 26 percent more likely to die from heart disease, 52 percent more likely to die from pneumonia or flu and 28 percent more likely to die from diabetes than other Virginians.

About 25 percent of the area’s residents have no health insurance.

Dr. Ross Isaacs of Charlottesville said numbers such as those are frustrating because most maladies are treatable if caught early enough. Isaacs, who specializes in kidney disease, said something as simple as monitoring blood pressure can help stop most of what ails people and increase life expectancy.

“These people urgently need treatment,” he said, getting visibly angry. “We need to put our resources into fighting” to get people adequate health care in the region.

“This is what we do — we take care of people,” Isaac said. “There isn’t a cash register between me and my stethoscope, nor should there be.”

Of the more than 3,000 people who will come into the fairgrounds this weekend, the majority will be there to see dentists.

About 53 percent of people here have no dental insurance, double the rate for the rest of the state, according to a study titled Health Care in Southwest Virginia. Those who do have coverage have limited choices in dentists.

The Virginia Dental Association in Richmond made the trip with a contingent of dentists and hygienists who set up camp in the middle of the fairgrounds with rows of chairs and trays of equipment. They will take x-rays, fill cavities, make dentures and pull teeth.

By Friday at 2 p.m., almost a thousand patients were waiting on metal seats under an awning to see the dentists. The crowd was muted. A few read books, some wrangled children and a great many smoked.

Dr. Terry D. Dickinson, executive director of the dental association, said the situation in the region is worsening as the price of gas and energy remains high.

“These people need to decide whether they are going to pay the rent or buy groceries for the kids. They’re not thinking about going to the dentist. They are just trying to survive,” he said. “But that they are here tells you how much they need this. Even with $4 gas, these people made the trip.”

RAM organizers expect a record crowd this year, almost double of what they saw in 2000, the first year the expedition came to Wise. The group does a total of 16 expeditions in the U.S.

“You see some of these people coming over and over,” said Dr. Lanny R. Levenson, a Midlothian dentist.

Contact Louis Llovio at (804) 649-6348 or LLLovio@timesdispatch.com.