PNHP

Blue Cross asks doctors to rat on patients

Blue Cross asks doctors to rat on patients

Doctors balk at request for data

By Lisa Girion
Los Angeles Times
February 12, 2008

The state’s largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients’ medical coverage.

Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose “material medical history,” including “pre-existing pregnancies.”

“Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately,” the letters say. The Times obtained a copy of a letter that was aimed at physicians in large medical groups.

(WellPoint spokeswoman Shannon) Troughton said Blue Cross sent the letters to medical groups that operate, in effect, as health maintenance organizations. Blue Cross pays such groups a set amount per patient each month. With a few exceptions, the groups are then responsible for arranging and providing patients’ medical care and take on a substantial piece of the risk.

Troughton said “in the past” physicians in such medical groups had requested information on patients’ pre-existing medical conditions because anything that had not been disclosed could affect the medical group’s finances.

It was important, Troughton added, “to note that participation in this outreach effort is voluntary on the part of the physicians.”

“We’re outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality,” said Dr. Richard Frankenstein, president of the California Medical Assn.

Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization, said the letter had put physicians in the “disturbing” position of having to weigh their patients’ interests against a directive from the company that, in many cases, pays most of their bills.

“They are playing a game of ‘gotcha’ where they are trying to use their doctors against their patients’ health interests,” Wright said. “That’s about as ugly as it gets.”

http://www.latimes.com/business/la-fi-bluecross12feb12,0,4319662.story

Comment:

By Don McCanne, MD

WellPoint’s Blue Cross of California remains a leader in introducing innovations that reduce expenditures for health care. By limiting spending on health care they have been able to market their insurance products at highly competitive premiums, thereby reaping profits on this large, very healthy sector of our population.

As we have seen before, Blue Cross’s very successful business model is often in conflict with the mission of physicians and other professionals to provide the health care that patients need. This letter to physicians has a particularly nefarious intent.

Since Blue Cross is paying these physicians a set amount per patient per month (capitation), the physicians themselves are providing an insurance function of assuming risk. Patients with greater health care needs result in a loss since the expenses required to care for them are greater, sometimes much greater, than the capitation payment made by Blue Cross.

So now we see why a physician might consider “ratting” on his or her own patient even though it would result in a rescission of the patient’s insurance policy. Blue Cross does not have to put in print the very strong message of this letter, even though it will jump out between the lines.

“Doctor, your dishonest patient who lied on the insurance application will result in a financial loss for you, not to mention the need to provide additional professional services for which you will not be compensated. Fortunately, you can prevent this loss by notifying us of any medical condition that will allow us to rescind this unfair insurance contract.”

To enhance profits, the private insurance industry is destroying the sacred relationship between the patient and his or her health care professional.

And the politicians are campaigning with the message that we can keep the private insurance we have. Who would want to?

Wyden's "Healthy Americans Act" is Wrong Model for Health Reform

Personal communication, Dr. Walter Tsou
February 12, 2008

The bipartisan authors of the Healthy Americans Act, Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) were in Philadelphia today for a two hour session to explain their bill. Their purpose was to build public support for their bill with the goal of having most of the disagreements worked out by the time a new president takes office in January 2009. The bill depends on the “mandate” model of private insurance. The potential problems with this approach have been extensively written about by PNHP.

Nevertheless, it was a unique meeting to have both Senators explain their bill and to sit with an audience for an hour to answer questions. The first tip off was that the forum was sponsored by AmeriHealth, a large Medicaid HMO. The Mayor of Philadelphia (who will be featured this Wednesday on ABC News with Charles Gibson) came to thank them for coming and stating his gratitude that someone in Washington was working on this problem. He came short of actually endorsing the bill however and conveniently left.

This left the program to Wyden and Bennett.

Wyden and Bennett said there were five major goals in their plan which was a piece in progress. Those goals were choice of plans to fit each family’s needs, portability which is tied to individual insurance supposedly with a lifetime guarantee of coverage as good as members of Congress (a term he used repeatedly), tax reform to support the same tax benefits that large employers get, healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite – market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care. Bennett says that many Republicans have a hard time even agreeing on universal health coverage.

Wyden mentioned that we spend $2.3 trillion on health care, but were not getting enough value for our money. In order to pay for the premiums to go to private insurers, they would require all employers to give all American workers the actual value of their health care benefits in higher wages but that they then turn around and require you to take those wages and purchase individual insurance. (This idea is something of value to single payer advocates but instead of paying premiums, you would pay taxes to fund a single payer plan. ) There would be three large private insurance risk pools. The first would be all employees who would basically buy into a program like the federal employee health benefit plans. The second would be all individual self employed and uninsured who would be in another big risk pool. In order to avoid adverse risk selection, they would require community rating by insurers and no preexisting condition exclusions. The third risk pool would be all Medicaid patients who could buy their insurance from Medicaid HMOs like AmeriHealth, but if the benefits were not as good as what members of Congress get, the federal government would subsidize these plans to ensure complete benefits. (actually, Medicaid benefits are generally much more comprehensive than private insurance, but because they pay so poorly, few providers accept Medicaid payments).

Several questions were asked, but my question basically challenged why they did not choose single payer since private insurers have much higher administrative costs, that single payer would be a much better negotiator of health prices and quality than Mrs. Jones down the street, and what kind of fines would they envision to enforce their mandate. Wyden stated that whenever he has a public forum, some single payer advocate explains the advantages of single payer and there is cheering in the audience. Then there is someone in the back of the room who denounces government. And finally, someone says “we want what you have”. Wyden pulls out his health card and says that he has private health insurance and explains that his plan would give Americans “what members of Congress have”. This seems to quiet the audience from his perspective. (I have no doubt that members of Congress do not face the denials so nicely outlined in Sicko.) In terms of transparency in prices and quality, Bennett said repeatedly that Utah’s Intermountain Healthcare delivers much better health care for less money and that presumably his state would benefit if there was more transparency in cost since they presumably would choose Intermountain Health. Bennett also seemed to believe that the risk pools were so huge that they could drop the private insurance overhead to “3-4 percent”, (which is sheer fantasy). They dodged the question about “fines” for enforcing the mandate, basically saying that terms like “garnish your wages” were words that opponents use and that basically the plan would deduct premiums from our paychecks in order to fund the plan. (Why deducting premiums from our paychecks to fund private insurance companies is acceptable but deducting a smaller amount using taxes to fund single payer was not acceptable seems an important question, but I wasn’t given a chance to debate them because so many others had questions.)

Others asked about malpractice, about whether states would be allowed to experiment with health care reform (they would), assurance of quality of care, etc.

They believe that since they have a bipartisan bill with six Republicans (Judd, Gregg, Grassley, Coleman, Crapo, Alexander) and six Democrats (Stabenow, Nelson, Lieberman (no surprise here), Carper, and Landrieu) plus the National Federation of Independent Businesses, the CEO of Safeway, and SEIU, they have a good shot at setting the framework for the next president. Add to that that Obama and Clinton are basically using the framework of private insurance in their plans and you have the basis to worry about another 4-8 years of a costly failed experiment in health care reform.

Despite these rumblings, I think it is pretty clear that the American people want single payer. It is the politicians who are out of tune with this. We will need to do a lot more educating about this. The impending recession may cause millions more Americans to lose their health insurance. Simply requiring them to buy insurance is not a solution in the face of a recession and we should demand that Congress create a real safety net, not one based on the fantasy that everyone buy overpriced for profit private insurance with huge deductibles.

Doctors balk at request for data

Physicians object to a letter from Blue Cross seeking information that could lead to policy cancellations.

By Lisa Girion
Los Angeles Times
February 12, 2008

Click here for a pdf of the Blue Cross Letter to health-care providers.

The state’s largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients’ medical coverage.

Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a letter advising them that the company has a right to drop members who fail to disclose “material medical history,” including “pre-existing pregnancies.”

“Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately,” the letters say. The Times obtained a copy of a letter that was aimed at physicians in large medical groups.

The letter wasn’t going down well with physicians.

“We’re outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality,” said Dr. Richard Frankenstein, president of the California Medical Assn.

Patients “will stop telling their doctors anything they think might be a problem for their insurance and they don’t think matters for their current health situation,” he said. “But they didn’t go to medical school, and there are all kinds of obscure things that could be very helpful to a doctor.”

WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, said Monday that it was sending out the letters in an effort to hold down costs.

“Enrolling an applicant who did not disclose their true condition (and the condition is chronic or acute), will quickly drive increased utilization of services, which drives up costs for all members,” WellPoint spokeswoman Shannon Troughton said in an e-mail.

“Blue Cross feels it is our responsibility to assure all records are accurate and up to date for HMO providers,” she said. “We send these letters to identify members early on in the process who may not have been honest in their application.”

Blue Cross is one of several California insurers that have come under fire for issuing policies without checking applications and then canceling coverage after individuals incur major medical costs. The practice of canceling coverage, known in the industry as rescission, is under scrutiny by state regulators, lawmakers and the courts.

Patients in a raft of lawsuits accuse the insurers of canceling coverage over honest mistakes and minor inconsistencies on applications that they contend are purposely confusing. Victims of cancer and other serious medical problems often are unable to get new coverage once their insurance has been rescinded and they may go without treatment when they need it most. Suddenly swamped by medical debt, some people have lost homes and businesses.

Insurers say the cancellations are an important weapon against fraud and occur rarely.

Physician groups and doctors who received the letter told The Times they never had seen anything like it. Also unfamiliar with such letters was Don Crane, executive director of the California Assn. of Physician Groups, which represents many of the large HMO-style medical groups.

“I have not heard any dialogue on this business of underwriting or ferreting out existing” conditions, Crane said.

But WellPoint’s Troughton said this was nothing new. “This is something that has been in place for several years and to date we have not received any calls or letters of concern for this service,” she said.

It was important, Troughton added, “to note that participation in this outreach effort is voluntary on the part of the physicians.”

The California Medical Assn. sent a letter to state regulators Friday urging them to order Blue Cross to stop asking doctors for the patient information, saying it was “deeply disturbing, unlawful, and interferes with the physician-patient relationship.”

The letters go out to some physicians who care for Blue Cross’ share of the state’s estimated 3 million people with individual policies.

Troughton said Blue Cross sent the letters to medical groups that operate, in effect, as health maintenance organizations. Blue Cross pays such groups a set amount per patient each month. With a few exceptions, the groups are then responsible for arranging and providing patients’ medical care and take on a substantial piece of the risk.

Troughton said “in the past” physicians in such medical groups had requested information on patients’ pre-existing medical conditions because anything that had not been disclosed could affect the medical group’s finances.

She disputed the notion that the letters could improperly breach patient confidentiality. She said the sharing of medical information with medical groups was within federal law because it fell under “patient, treatment and operations” guidelines.

Blue Cross doesn’t always cancel the policies of patients with discrepancies in their applications, Troughton noted. Sometimes it may offer them another plan, she said.

Lynne Randolph, a spokeswoman for the state Department of Managed Health Care, said the agency would review the letter. Blue Cross is fighting a $1-million fine the department imposed in March over alleged systemic problems the agency identified in the way the company rescinds coverage.

A spokesman for state Insurance Commissioner Steve Poizner said the Insurance Department had not received any complaints about Blue Cross’ letter. But because the medical association had sent a copy of its complaint to the department, the letter is “on our radar now,” spokesman Byron Tucker said.

The letter is “extremely troubling on several fronts,” Tucker said. “It really obliterates the line between underwriting and medical care. It is the insurer’s job to underwrite their policies, not the doctors’. Doctors deliver medical care. Their job is not to underwrite policies for insurers.”

Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization, said the letter had put physicians in the “disturbing” position of having to weigh their patients’ interests against a directive from the company that, in many cases, pays most of their bills.

“They are playing a game of ‘gotcha’ where they are trying to use their doctors against their patients’ health interests,” Wright said. “That’s about as ugly as it gets.”

lisa.girion@latimes.com

Wyden’s “Healthy Americans Act” is Wrong Model for Health Reform

Personal communication, Dr. Walter Tsou
February 12, 2008

The bipartisan authors of the Healthy Americans Act, Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) were in Philadelphia today for a two hour session to explain their bill. Their purpose was to build public support for their bill with the goal of having most of the disagreements worked out by the time a new president takes office in January 2009. The bill depends on the “mandate” model of private insurance. The potential problems with this approach have been extensively written about by PNHP.

Nevertheless, it was a unique meeting to have both Senators explain their bill and to sit with an audience for an hour to answer questions. The first tip off was that the forum was sponsored by AmeriHealth, a large Medicaid HMO. The Mayor of Philadelphia (who will be featured this Wednesday on ABC News with Charles Gibson) came to thank them for coming and stating his gratitude that someone in Washington was working on this problem. He came short of actually endorsing the bill however and conveniently left.

This left the program to Wyden and Bennett.

Wyden and Bennett said there were five major goals in their plan which was a piece in progress. Those goals were choice of plans to fit each family’s needs, portability which is tied to individual insurance supposedly with a lifetime guarantee of coverage as good as members of Congress (a term he used repeatedly), tax reform to support the same tax benefits that large employers get, healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite – market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care. Bennett says that many Republicans have a hard time even agreeing on universal health coverage.

Wyden mentioned that we spend $2.3 trillion on health care, but were not getting enough value for our money. In order to pay for the premiums to go to private insurers, they would require all employers to give all American workers the actual value of their health care benefits in higher wages but that they then turn around and require you to take those wages and purchase individual insurance. (This idea is something of value to single payer advocates but instead of paying premiums, you would pay taxes to fund a single payer plan. ) There would be three large private insurance risk pools. The first would be all employees who would basically buy into a program like the federal employee health benefit plans. The second would be all individual self employed and uninsured who would be in another big risk pool. In order to avoid adverse risk selection, they would require community rating by insurers and no preexisting condition exclusions. The third risk pool would be all Medicaid patients who could buy their insurance from Medicaid HMOs like AmeriHealth, but if the benefits were not as good as what members of Congress get, the federal government would subsidize these plans to ensure complete benefits. (actually, Medicaid benefits are generally much more comprehensive than private insurance, but because they pay so poorly, few providers accept Medicaid payments).

Several questions were asked, but my question basically challenged why they did not choose single payer since private insurers have much higher administrative costs, that single payer would be a much better negotiator of health prices and quality than Mrs. Jones down the street, and what kind of fines would they envision to enforce their mandate. Wyden stated that whenever he has a public forum, some single payer advocate explains the advantages of single payer and there is cheering in the audience. Then there is someone in the back of the room who denounces government. And finally, someone says “we want what you have”. Wyden pulls out his health card and says that he has private health insurance and explains that his plan would give Americans “what members of Congress have”. This seems to quiet the audience from his perspective. (I have no doubt that members of Congress do not face the denials so nicely outlined in Sicko.) In terms of transparency in prices and quality, Bennett said repeatedly that Utah’s Intermountain Healthcare delivers much better health care for less money and that presumably his state would benefit if there was more transparency in cost since they presumably would choose Intermountain Health. Bennett also seemed to believe that the risk pools were so huge that they could drop the private insurance overhead to “3-4 percent”, (which is sheer fantasy). They dodged the question about “fines” for enforcing the mandate, basically saying that terms like “garnish your wages” were words that opponents use and that basically the plan would deduct premiums from our paychecks in order to fund the plan. (Why deducting premiums from our paychecks to fund private insurance companies is acceptable but deducting a smaller amount using taxes to fund single payer was not acceptable seems an important question, but I wasn’t given a chance to debate them because so many others had questions.)

Others asked about malpractice, about whether states would be allowed to experiment with health care reform (they would), assurance of quality of care, etc.

They believe that since they have a bipartisan bill with six Republicans (Judd, Gregg, Grassley, Coleman, Crapo, Alexander) and six Democrats (Stabenow, Nelson, Lieberman (no surprise here), Carper, and Landrieu) plus the National Federation of Independent Businesses, the CEO of Safeway, and SEIU, they have a good shot at setting the framework for the next president. Add to that that Obama and Clinton are basically using the framework of private insurance in their plans and you have the basis to worry about another 4-8 years of a costly failed experiment in health care reform.

Despite these rumblings, I think it is pretty clear that the American people want single payer. It is the politicians who are out of tune with this. We will need to do a lot more educating about this. The impending recession may cause millions more Americans to lose their health insurance. Simply requiring them to buy insurance is not a solution in the face of a recession and we should demand that Congress create a real safety net, not one based on the fantasy that everyone buy overpriced for profit private insurance with huge deductibles.

End fringe debate over mandates – Kuttner

Examining Clinton & Obama's Stances on... Universal Healthcare...

Amy Goodman and Juan Gonzalez interview Robert Kuttner
Democracy Now!
February 8, 2008

Amy Goodman: Let’s talk about the healthcare plans of Hillary Clinton and Barack Obama.

Robert Kuttner: …Clinton has what’s known as a mandate. She requires people to get coverage. Obama doesn’t. Clinton and some liberal commentators, like Paul Krugman, have whacked Obama for not having a mandate. I think a mandate is a very bad idea. I think the difference between universal social insurance and a mandate is that universal social insurance, like Medicare, says that, as an American or a permanent resident of the country, you get health insurance, the same way you get Social Security. A mandate takes a social problem and makes it the individual’s problem. And in the Massachusetts version of this, on the website it says “new penalties for 2008.” You get penalized if you don’t buy health insurance, even if the health insurance that’s available is not high quality and is not affordable.

The other problem with this whole approach is that you don’t get the cost efficiencies that you get from universal health insurance, because you still have all this paperwork, you still have all the profit by private insurance companies, you still have doctors being given incentives to go for the reimbursable procedures. And as a result, the cost-containment pressures hit patients. They come in the form of less care, rather than in the form of less waste.

Juan Gonzalez: …both Krugman, in his various articles, and Clinton have claimed, on the one hand, that Obama does have mandates — he has mandates for coverage of all children — so that the mandates issue is not a principled issue, it’s a tactical issue as to what you think could be approved. Your sense of that?

Robert Kuttner: My point is that a mandate, in a situation where the whole system is sick, makes that sickness the problem of the individual. Instead of putting a gun to people’s heads, typically people who can’t afford good quality insurance, and saying to them, “You must, under penalty of law, or pay a tax or pay a fine, go out and find decent insurance,” it’s so much better policy to just have insurance for everybody. Then there’s no question of a mandate.

I think it’s a very bad position for progressives to back into, because it signals that government is being coercive, rather than government being helpful. Now, we can split hairs and argue whether Obama is being principled or tactical, but I think his discomfort with the idea of a mandate is something that I applaud. I wish that both he and Clinton had gone all the way and said, let’s just to do this right and have national health insurance. I think they could have used this as a teachable moment. They could have bought public opinion around. Medicare is phenomenally popular. Medicare is national health insurance for seniors. Let’s have national health insurance for everybody.

(Clip of Clinton/Obama debate)

Amy Goodman: It’s interesting to note something Hillary Clinton says in that clip. When she mentions a single-payer system, the audience applauds and cheers, even though it’s an option rarely seriously discussed by politicians or the corporate media. And Hillary Clinton acknowledges the applause by saying, “I know a lot of people favor [it], but for many reasons [it’s] difficult to achieve.” She doesn’t explain why she thinks it’s difficult to achieve. And polls repeatedly show a majority of Americans favor it. An A.P. poll in December found nearly two-thirds of voters want universal healthcare, in which everyone’s covered in a Medicare-type program, while more than half of voters explicitly said they support single payer. But it’s the insurance companies that are against it. Robert Kuttner, can you talk about that?

Robert Kuttner: Well, one of the reasons that it’s difficult to achieve is the lack of leadership on the part of leaders like Hillary Clinton and, for that matter, Barack Obama. I mean, if you had Hillary Clinton and Barack Obama say, “You know, this is an intramural debate that we should not be having, this debate about mandates; we should do this right: we should have national health insurance,” public opinion would turn around on a dime. And instead of it being this fringe idea, all of a sudden, just because the two of them had blessed it, it would become a mainstream idea, and we would be having a debate that we should have been having all along.

http://www.democracynow.org/2008/2/8/examining_clinton_obamas_stances_on_the

Comment:

By Don McCanne, MD

Talk about incompetent framing of the health care reform debate. Clinton and Obama are engaged in a cat fight over coercing the purchase of unaffordable and inadequate private plans, versus allowing individuals to go without coverage because it is unaffordable. Neither is acceptable.

Robert Kuttner is right. We need leadership on this issue. Affordable, comprehensive health care for everyone is fundamental to the Democratic position on reform, whereas this fundamental principle is nowhere to be found in the Republican proposals.

Either party could pull it together and support a universal, comprehensive national health program. For Democrats, it would require only minor policy adjustments and a revision of the framing. Republicans would have to build an entirely new policy infrastructure.

Barack Obama has said that, if starting anew, he would support a single payer system. Hillary Clinton understands that there is considerable public support for single payer and has said that she would sign a single payer bill if it came to her desk as president. So, how about showing a little leadership? Both of you.

Estimated cost of state's health plan raises alarm

Letters to the Editor
Boston Globe
February 10, 2008

JONATHAN GRUBER suggests that a single-payer system “would cost many multiples” of the current effort to expand health insurance coverage in Massachusetts through an individual mandate (letters, Feb 1) (http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2008/02/01/recognizing_progress_in_massachusetts_health_reform) Yet at least 18 studies conducted since 1991, including two that examined single-payer plans for Massachusetts in 1998, have found that a single-payer plan could provide comprehensive coverage for everyone while costing less than is now being spent. Savings in insurance overhead and hospital and physician office billing costs would more than offset the cost of providing access to care for those who now don’t have it. Massachusetts should reconsider this cost-effective alternative to the increasingly costly approach now being attempted.

LEONARD RODBERG
New York

The writer is a research director with Physicians for a National Health Program

Prescription for change

Hoosier doctor leads drive to fix ailing health system

By Daniel Lee
The Indianapolis Star
February 9, 2008

Dr. Rob Stone was a teenager in Southern Indiana when he felt the call to become a physician.

It began during a stint as a counselor at a camp in Tell City for children with disabilities. An Ivy League education and career as a doctor followed.

Then, decades later, came a second calling: He became an agitator for changing the nation’s health-care system.


Danese Kenon / The Star

Passion for public service: Bloomington doctor Rob Stone
consults with Lori Wilbur, Bloomington, at the Volunteers in
Medicine of Monroe County clinic. Stone, co-founder of
Hoosiers for a Commonsense Health Plan, donates time to
the clinic that serves the uninsured.

Stone, an emergency room physician at Bloomington Hospital, has emerged as one of Indiana’s most outspoken advocates for making insurance accessible to all. He is co-founder and director of Hoosiers for a Commonsense Health Plan, which contends that the current system is too profit-driven, too inefficient, and leaves too many people without affordable access to health care.

HCHP — made up of doctors, nurses, social workers, patients and others — is an affiliate of the national Physicians for a National Health Program.

From its founding in September 2005, HCHP has grown from a small band of advocates to a statewide citizens group with dozens of active volunteers and an e-mail list of more than 1,500.

Stone, 55, said his motivation stems from his many years of seeing the struggles of patients needing care.

“It started dawning on me just how crazy our current system is, and the cost shifting and the crazy patchwork quilt of payer sources, just how insane the system seems to be,” Stone said. “That, coupled with watching as the ER became more and more of the safety net for the uninsured.”

Stone brings that message to Indianapolis today during a public forum titled “Understanding the Health Care Crisis: Problems and Solutions,” which runs from 9 a.m. to noon at Indianapolis First Friends, 3030 Kessler Blvd., East Drive.

One of Stone’s favorite targets is Indiana’s largest health-care insurance provider, Indianapolis-based WellPoint, a $61 billion health insurance giant that provides coverage to 35 million people in America.
“WellPoint epitomizes our system,” he said. “They’re it.”

Stone’s PowerPoint presentation lays out his case. A Medicare-type program for all is better than the current system, he says. Medicare is currently for the elderly.

One slide — with information attributed to the International Journal of Health Services in 2005 — shows Medicare overhead spending was 3.1 percent of its budget, compared with 26.5 percent for investor-owned Blue Cross and Blue Shield plans.

Another slide — with information from the Employer Health Benefits Annual Survey and Bureau of Labor Statistics — showed that from 2000 to 2006 health insurance premiums rose 87 percent while workers’ earnings rose 18 percent.

About 47 million Americans, including 750,000 Hoosiers, are without health insurance.
It’s a complex and uphill battle.

” ‘Single payer’ is not a phrase that is rolling off anyone’s lips in the presidential race, with the exception of Dennis Kucinich,” said Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a Washington, D.C.-based research group.

Many Americans, she said, tend not to be interested in what they consider a government solution to the health-care crisis. Cassil said hospitals, insurers, device makers and many doctors benefit from the current system.

But Stone does have some allies. Physicians for a National Health Program was founded by two Harvard professors of medicine, David Himmelstein and Steffie Woolhandler, and has grown to more than 14,000 members.
“They’re a very dedicated, committed group,” Cassil said.

Groups like Stone’s, while small in the number of physicians who take part, are credible advocates because they’re out on the front lines of medicine and often stand to lose income if the reforms they seek ever become reality, Cassil said.

For its part, WellPoint sees having a competitive, free-market system as key to improving the quality of care and controlling costs.

“We believe a single-payer health-care system would hinder progress in these areas by eliminating competition and restricting patient choice and could require patients to endure long wait times for care while possibly reducing the quality of health care,” WellPoint spokesman Jim Kappel said in an e-mail.

In its recent earnings report, WellPoint touted that it lowered its administrative expenses to 14.5 percent of premium revenue in 2007 from 15.7 percent in 2006 even as it added 708,000 members.

The company also pointed to flaws in other nations’ health-care systems.

“In Canada, which has a single-payer system, the average wait between a general practitioner referral and a specialty consultation at times has been longer than 17 weeks.”

Stone stands by his position. He recalls a patient who refused to seek treatment for chest pains that turned out to be a heart attack. He finally sought treatment for a second attack, only because the first attack left him disabled — but now eligible for government coverage.

The physician has scaled back his work at Bloomington Hospital to two shifts a week to devote more time to HCHP. He volunteers at a clinic for the uninsured and serves on the hospital’s board and as chief of its medical staff. He also is a partner of his physician practice, Unity Physician Group.

Stone and his wife, Karen Green Stone, who heads HCHP’s education committee, live in a home that Stone built outside Bloomington. Their home is unofficial headquarters for the state organization.

He is finding many people who are willing to listen.

“Dr. Stone put together an incredible amount of information. It was very eye-opening,” said Beth Henricks, a tax consultant and Geist-area resident who saw Stone’s presentation to a group of executives several months ago in Indianapolis. “When I see somebody who’s that passionate, that’s really appealing to me.”

Stone’s point that the United States already has a “single-payer” program in Medicare that covers millions seemed to make sense, said Henricks, whose company First Advantage has faced annual health insurance premium increases of 20 percent to 25 percent in recent years.

“Medicare works pretty well, and it’s been around for a long time, so why not pattern something after Medicare?”

Veterans are growing segment of the uninsured in America

By Dr. Rob Stone
Bloomington Herald Times
Guest Column
February 9, 2008

Recently I heard someone refer to those without health insurance as “losers.” It made my blood boil. The implication was that they had made poor choices and didn’t “deserve” health care.

Of the 47 million without health insurance in this country, about 18 percent are children. The majority of the uninsured work, many at more than one job, but either they work a job that doesn’t offer insurance, or if it is offered, they can’t afford it.

Many of them made the mistake of getting sick, and now that they have diabetes or cancer, they have a “pre-existing condition,” and cannot get coverage for any affordable price. Is it an American value to dismiss children, sick adults, and working people as “losers”?

A newly published study from Harvard in the American Journal of Public Health (Himmelstein, Woolhandler, et al, December issue) adds a new sad story to the picture — another bunch of losers — American veterans. Almost 2 million of the uninsured are veterans, along with almost 4 million of their family members, so that one in every eight uninsured is a veteran or member of a veteran’s household.

The number of uninsured vets is up 290,000 since 2000, and many are barred from VA care because of a 2003 Bush administration order that halted enrollment for most middle-income veterans.

Uninsured veterans have as much trouble getting medical care as other uninsured people; 26 percent of uninsured veterans reported that they had failed to get needed care due to costs; 31 percent had delayed care due to costs; 49 percent had not seen a doctor within the past year; and two-thirds failed to receive preventive care. And like the uninsured in general, nearly two-thirds of uninsured veterans are working.

“Since President Bush took office, the number of uninsured vets has skyrocketed, and he’s cut eligibility, barring hundreds of thousands of veterans from care. This administration has put troops in harm’s way overseas and abandoned them and their families once they got home,” said Dr. David Himmelstein, coauthor of the study and co-founder of Physicians for a National Health Program. “We need a solution that works for veterans, their families, and all Americans — single payer national health insurance.”

I went into medicine to care for the sick. Everyone who is sick has lost something, and the health care system is supposed to help. Yes, we have winners and losers in America. Anthem and the other insurance companies are making record profits, so they look like winners. Wall Street loves them. But there are too many losers, like the millions of veterans and their family members who cannot get health care. Let’s not write off the uninsured as losers — let’s figure out how to make us all winners.

I work in the emergency room, and every day I take care of people who are afraid to come to a doctor because they know they can’t pay the bill, who fear the cost as much as they fear the diagnosis I may give them. They have lost something. Most have lost piece of mind. Many have lost dignity. Some have lost hope. It’s disgraceful that some would rather write them off as losers, and turn away.

It’s a matter of values. As Americans, we take care of each other. We take care of the young, the elderly, and the sick. We should take care of veterans. We should take care of everyone. Let’s work together to get health care for all.

This guest column was written by Rob Stone, a Bloomington physician.

Hey, candidates: selling insurance no health plan

By Rose DeMoro
Guest Column
Waco Tribune
Sunday, February 10, 2008

With the presidential contest closing in on Texas, voters may well wonder how to distinguish among the various candidates on health care, which — at least on the Democratic side — has been one of the hottest issues of debate.

The central difference is on the role of insurance. Why does this matter?

Listen to Lyle Schiele of Dallas.

“As an owner/operator in the trucking industry, I was contracted to a major trucking company. I purchased my health insurance at what was to me an enormous monthly cost of $760 through that company.

“In February ’06 I had some minor chest pains. Doctors found clogged coronary arteries and treated them with stents in two locations. As a result of this diagnosis and treatment, I was medically disqualified from trucking for 90 days. As a contractor, I wasn’t covered by COBRA and therefore lost my health insurance.

“After returning to trucking as an owner/operator and applying with several different insurance companies, I found none would sell me any. Recently, as a matter of necessity, I sold my truck and went to work as a driver with a company, primarily for the health insurance benefit.

“I was not looking for a handout. I don’t mind paying my own way. But I am no longer given that opportunity. The ‘American Dream’ of owning and operating one’s own business and success based on one’s ability and performance has been taken away. Because of the health insurance issue I can no longer operate as an independent again.”

Lyle is one of hundreds who responded to a California Nurses Association/National Nurses Organizing Committee ad describing the disparity of care available to Vice President Cheney and members of Congress and the rest of us (www.cheneycare.org).

His story is not unique. One in six insured adults has substantial problems paying medical bills, one report noted last year, and 42 percent told Zogby-UPI pollsters that their insurer had refused to pay a medical bill.

Yet, selling us more insurance — without ending insurance industry price gouging or the callous, all too routine denials of care — is at the heart of the leading candidates’ proposals in both parties.

Republicans mainly emphasize tax incentives and further unleashing a market that has already ushered in an 87 percent increase in insurance premiums alone the past decade, not counting the co-pays, deductibles and other staggering costs.

Top Democrats favor a more comprehensive approach with expanded public programs for children and the poor. But only Sen. Hillary Clinton is pushing an “individual mandate,” the requirement for everyone to buy insurance with no meaningful controls on its cost or assurances that you won’t be denied care when you need it.

Sen. Barack Obama says people don’t have insurance not because they don’t want it, “but because they can’t afford it.” He has a point.

A Kaiser Family Foundation 2007 survey found that family premiums now average $12,106 — not including all the add-ons.

Clinton’s argument that Obama is “leaving out” people by objecting to the mandate, and that requiring everyone to buy insurance constitutes “universal health care” is disingenuous.

“Having” insurance is not the same as being able to use it. You’re only being mandated to purchase the premiums; they’re not mandating the insurance companies to make sure you get the care you need.

Clinton has also criticized Obama for his past comments about a real alternative to an insurance-based system. In 2003 Obama called himself “a proponent of single-payer, universal healthcare coverage . . . everybody in, nobody out” — essentially an expanded and improved Medicare for all.

It’s a system, with some nuances, in place in every other Western country, and it works. A January, study by the London School of Hygiene and Tropical Medicine, for example, found the U.S. ranked worst among 19 industrial nations in preventable deaths.

Those results should make such a system a model for the U.S., not a campaign attack point.

What Obama says now, as he did again in a recent debate in South Carolina, is “if I were designing a system from scratch, I would set up a single-payer system.”

We are starting from scratch. Our present system has hit rock bottom, as Lyle and so many others can attest. Our families deserve no less.

Rose Ann DeMoro is executive director of the 80,000-member California Nurses Association/National Nurses Organizing Committee and a national vice president of the AFL-CIO.

AMA's Conflicted President

By Adam Doster
In These Times
February 11, 2008

Dr. Nancy Nielsen’s résumé is exhaustive. Currently a clinical professor of medicine and senior associate dean for medical education at the University of Buffalo School of Medicine and Biomedical Sciences, Nielsen has worked for the New York State Department of Health and has held various leadership positions in the American Medical Association (AMA). So it’s not surprising that the AMA voted her president-elect last June, only the second woman to hold the post. Yet other jobs on Nielsen’s résumé have alarmed some progressive healthcare advocates.

From October 2004 to July 2007, Nielsen served as chief medical officer of Independent Health Association, a Buffalo-based HMO. Although AMA spokesperson Brenda Crane notes that Nielsen ended her affiliation with Independent Health upon receiving her promotion at the AMA, her tenure raises flags for Geri Jenkins, president of the California Nurses Association, a healthcare union.

“I think you have a conflict when you have someone in that position who’s worked for an insurance company and is also a physician who’s going to run the AMA,” Jenkins says.

Since 1996, Nielsen has also sat on the board of the Medical Liability Mutual Insurance Company, one of the country’s largest medical liability carriers. While some Republicans have embraced medical malpractice reform as a virtual cure-all for America’s healthcare crisis, critics contend that putting caps on non-economic damages provides unjustified protections for hospitals, HMOs and insurance companies, another potential conflict of interest.

In a vacuum, Nielsen’s professional relationships might be considered inconsequential. But the AMA has a long history of thwarting progressive healthcare reform, which amplifies the importance of her connection to the insurance industry.

As early as the 1930s, then-AMA President Dr. Morris Fishbein wrote that a national healthcare program would cause “a weakening of national caliber,” and signal “a definite step toward either communism or totalitarianism.” When, in 1948, President Harry Truman called for the creation of a government-run national health insurance fund, the AMA characterized the bill as “socialized medicine” and campaigned against it.

Next came the 1961 battle over Medicare that pitted the Kennedy administration against a recently hired General Electric public-relations flak named Ronald Reagan. The future president recorded an LP titled “Ronald Reagan Speaks Out Against Socialized Medicine” that the AMA distributed to housewives across the country. “Operation Coffee Cup” architects suggested that women organize small gatherings, brew some java and listen to the dangers that a national healthcare system would invariably pose.

During the Clinton years, the AMA was active in the coalition that beat back “Hillarycare”–the Democrats’ last attempt at major healthcare reform.

In August, the AMA launched a $15 million advertising campaign that focused on the problems of the uninsured, hoping to persuade voters to cast their ballots in 2008 with the issue in mind. But this project has frustrated reformers, who contend that the organization’s approach to achieving universal care–providing tax breaks and vouchers for those lacking coverage so they can purchase affordable plans–is too timid.

“At best Ć¢ā‚¬Ā¦ the AMA is advocating a completely unproven method of achieving their ends and ignoring things that we know will work,” says Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program.

Given these realities, many doctors are turning their backs on the AMA. The medical news service MedPage Today estimated that the AMA represented only 15 percent of practicing U.S. physicians in 2005, down from 70 percent during the 1961 Medicare fight.

“A lot of younger doctors,” says Jenkins, “have gone into other groups and organizations because they haven’t always been happy with how the AMA is run and what they do.”

States like Minnesota and Massachusetts show majority support among physicians for a single-payer system, and the American College of Physicians–America’s second-largest physician group–endorsed such a proposal in December.

That’s made no difference to the AMA.

“The AMA has stuck with this position of vehemently opposing national health insurance,” says Woolhandler, “despite a major shift in the physician community in terms of opinion.”

With Nielsen at the helm, the AMA’s intransigence seems likely to continue.

Universal health care: U.S. could outdo Canadians

By Elizabeth Kurczynski and Allen Chauvenet
West Virginia Gazette
February 10, 2008

As physicians who treat children with blood diseases and cancer at Women and Children’s Hospital, we frequently see families with either inadequate insurance coverage or no coverage at all. These are almost always working families with one or both parents who have a steady job.

These families are part of the 47 million Americans and the 322,000 in West Virginia with no health insurance coverage. Even families with “good” coverage are paying more per year with much higher co-payments and deductibles, since the cost of health insurance for a family is now over $12,000 per year.

Most Americans realize that our health-care system is in crisis. All of the presidential candidates propose incremental changes that would offer more people the opportunity to “buy” coverage, or offer families small grants to help them buy a cheaper insurance plan that provides only adequate coverage for those who are healthy. How many can afford $12,000 a year?

Dennis Kucinich is the only candidate who favors a nationwide single-payer health plan, which would provide coverage for everyone for all health-care needs, including drugs. Everyone who votes should know that this plan exists. It is an affordable alternative to more insurance. It could cover everyone for no more money than the $7,500 per person per year that we are currently spending for health care in the United States.

In the past, Barack Obama has said that a single-payer plan is the best health plan, but he now says that it is not politically feasible. In other words, our elected representatives feel that the insurance and drug lobbying interests are too powerful to fight. But these are the people we elect to support our interests nationally!

Thousands of physicians and many organizations such as the American College of Physicians and The Charleston Gazette have endorsed a single-payer universal health plan. Physicians for a National Health Plan is a national group that has been working for a single-payer plan for the past 20 years (PNHP.org). We have a Mountaineer Chapter of PNHP here in Charleston. Every other Western country covers everybody. We can do it, too.

Such a system would be similar to the Canadian health system, but better funded, since the Canadians pay less than $4,000 per person for health care. A single-payer system would be supported by tax dollars – about 6 percent for businesses, and about 2 percent for individuals, less than we currently pay. But the system would be privately run, and patients could choose their own physicians and hospitals. Everything would be covered, including doctors, hospital stays, long-term care, mental health, dental and vision care and prescription drugs. Hospitals would be given a lump sum for the year, and would not have to negotiate with and bill dozens of separate insurance companies. Physicians would be paid a set amount for specific services, and would no longer have to employ billing clerks to fill out many different complex insurance forms to receive reimbursement at a reduced rate.

Administrative costs in our current health-care system are between 30 and 40 percent of our total health-care costs, whereas a single-payer plan such as Canada’s system, Medicaid, Medicare or the Veterans Administration health-care system, has only about 3 percent administrative costs. This dramatic savings would be enough to provide complete coverage for everyone in the United States.

Many polls have clearly shown that at least 65 percent of Americans want national health insurance, and over 97 percent of Canadians like their health-care system and would not want a U.S.-style system. How have we let our system get to the point where it is run by for-profit insurance companies whose goal is to deny care and to make more money for their Wall Street stockholders? Our Mountaineer chapter of Physicians for a National Health Plan would like all West Virginians to learn about a better alternative that can provide universal care, and eliminate the inequality and injustice in our current system.

Kurczynski and Chauvenet are both pediatricians and professors with WVU in Charleston.

Universal health care: Advocate discusses Pennsylvania single-payer plan

By CHRIS KELLY
The Evening Sun
02/07/2008

Imagine a world without worrying if a doctor could see you – or if you could pay the bill. A world where all Pennsylvanians can afford health care.

That’s the world discussed Wednesday night by Chuck Pennachio at Gettysburg Area Democracy for America’s meeting.

Pennachio, the executive director of Healthcare for All Pennsylvania and a former candidate for U.S. Senate, told the group the effort to bring universal health care to all Americans started decades ago with former President Harry Truman. He says it would have made America better. A similar plan was proposed by presidential hopeful U.S. Sen. Hillary Clinton in the early 1990s. Pennachio told the group that gathered in a room inside Valentine Hall at the Lutheran Theological Seminary that two health-care-reform plans – collectively dubbed the Family and Business Health Care Security Act – are making their way through the state Legislature as Senate Bill 300 and House Bill 1660.

The act would replace the existing health-insurance system, which typically

grants coverage through a person’s employer, with a government-run system known as single-payer universal health care. Single-payer health care would be paid for with existing state and federal funds, a 10-percent payroll contribution from all employers and a 3-percent personal income tax. The money would be paid into the Pennsylvania Health Trust and be used exclusively for health care, Pennachio said.

“I’m very intrigued by (the act),” said Elaine Jones, chairwoman for the Gettysburg Area Democracy for America, a self-described a grassroots network looking to re-establish democratic values. “I think it should be debated in Pennsylvania and I think it could be a wonderful solution,” Jones said.

If approved by the Legislature and Gov. Ed Rendell, the plan would result in a huge savings for most individuals and employers.

“Although that does sound like much, we are paying at least double that for health care now,” Pennachio said.

Savings would result from the elimination of for-profit and growth-driven insurance companies that tack on extra payments, Pennachio said. It would reduce the cost of billing and collection and do away with managed-care systems that dictate which doctors patients can see, he said.

“Employees would be able to go to a different job if they wanted,” Pennachio said. “There would be no scare of not being able to afford health coverage.”

He said the plan would eliminate the cost of private insurance plans, co-pays and deductibles.

Jones said the group was glad Pennachio provided them with more information on the act.

“The only way (health-care reform) can happen is if concerned citizens learn the facts and get their representatives to do the right thing,” she said.

The Family and Business Health Care Security Act needs 102 of 203 votes in the House, 26 of 50 in the Senate, and the governor of Pennsylvania to approve the bill in order for it to become law.

Pennachio says this is an easy bill to pass if the citizens want it. He said community members should lobby their state legislators and make them aware that that they support the bill.

Tim Macchio’s comment: Remember that the taxes would replace the existing premiums, co-pays and deductibles.

For more information, visit http://www.healthcare4allpa.org