PNHP

Just Off Insular Senate Floor, Life of the Uninsured Intrudes

Just Off Insular Senate Floor, Life of the Uninsured Intrudes

By ROBERT PEAR
The New York Times
November 25, 2007

WASHINGTON, Nov. 24 — When senators debate health care, they usually speak in abstract terms about soaring health costs and the plight of the uninsured.

But just 20 feet from the Senate chamber is a young man who knows those problems all too well from personal experience. The man, Sergio A. Olaya, runs the Capitol elevators on which the senators ride. Whenever the Senate is in session, he is on duty.

Mr. Olaya, 21, is struggling with $255,000 of medical bills incurred by his mother before she died in April from an aggressive form of brain cancer.

A local hospital and its collection agency have been hounding him in an effort to collect from his mother’s estate, Mr. Olaya said. To pay the bills, he is selling the Maryland home where he lived with his mother, Clara Ines Olaya, 61.

His experience highlights the problems of the uninsured, from which members of Congress are usually insulated. The leading Democratic presidential candidates say all Americans should have coverage as good as what Congress has.

As a government employee, Mr. Olaya has health insurance. But his mother, like 47 million other Americans, was uninsured.

“I wonder how many senators have been in the elevator with Sergio, talked to him, shared a smile with him, but had no idea of the terrible burden he and his mother were carrying,” said Senator Richard J. Durbin of Illinois, the Senate Democratic whip, who learned of Mr. Olaya’s problems from an aide.

In an interview, Mr. Olaya said: “I’m just a college kid. I don’t have financial support from anyone. Paying $255,000 for medical bills derails my ability to pay for college.”

Senators have access to a wide range of insurance options through the Federal Employees Health Benefits Program. Congress has its own “attending physician” — actually, a team of 5 doctors and 14 nurses who work in the Capitol and nearby Congressional office buildings. Lawmakers can fill prescriptions at a small pharmacy in the Capitol. For more serious problems, they can use nearby military hospitals.

But Congress is far from agreement on any comprehensive proposals to help the uninsured. Even legislation to cover children has been caught up in a furious battle with President Bush over the proper role of government in providing insurance.

Senators are not normally exposed to the fears that strike many workers as employers reduce health benefits and insurers increase premiums year after year. Annual increases of 20 percent or more are not unusual for small businesses. The National Federation of Independent Business, a lobby for small business owners, says health costs are their top concern.

Since 2000, the number of uninsured, as reported by the Census Bureau, has increased by 8.6 million, or 22 percent. Some private studies suggest that one in three Americans under the age of 65 may have been uninsured at some time in the last two years.

“The truth is, almost every family is at risk because of a fraying health care safety net,” Mr. Durbin said. “Almost all of us could be one pink slip, one election, one bad diagnosis or one serious accident away from a health and economic disaster. This affects Sergio, a member of our Senate family. It affects all families.”

One lawmaker, Senator Sherrod Brown, Democrat of Ohio, has refused to accept the health insurance available to members of Congress. He says he will not take it until all Americans have access to affordable coverage.

Former Senator John Edwards, a candidate for the Democratic presidential nomination, said, “There is no excuse for politicians in Washington having health care when America has no health care.”

Mr. Edwards has been conveying that message to Iowa voters in 30-second television commercials. On his first day in office, he said, he will “submit legislation to end coverage for the president, all members of Congress and all senior political appointees in the legislative and executive branches of government on July 20, 2009 — unless Congress has enacted universal health insurance.”

One of his rivals for the nomination, Senator Hillary Rodham Clinton of New York, said she would “give all Americans the same set of insurance options that their members of Congress have.” This, she said, could be done “without any new bureaucracy.”

Another Democratic presidential contender, Senator Barack Obama of Illinois, said that under his proposal for universal coverage, everyone would have access to “health care that is as good as the health care that I have as a member of Congress.”

While waiting for such coverage, many Americans will wrestle with debts like those facing Mr. Olaya, the Senate elevator operator. He had been a student at the University of Delaware, but said he would not return until he paid his mother’s medical bills.

His mother, an expert on health and nutrition, was born in Colombia, received a master’s degree from Stanford in 1981 and became a United States citizen in 1994. She had health insurance in most of her jobs over the last 20 years, at the Centers for Disease Control and Prevention, the United States Agency for International Development, Unicef and other organizations.

But she had been unemployed and uninsured since December.

Mrs. Olaya had applied for a new federal job. When the job offer finally came in March, her son said, she had just suffered a stroke and could not get out of bed to answer the telephone. In another month or two, she might have had health coverage through her new job. In another four years, she would have been eligible for Medicare.

“Instead,” Senator Durbin said, “she had the bad luck and bad timing to fall through one of the gaping holes in America’s unraveling health care safety net. Now her only child, her son, is paying the price.”

Study finds immigrants’ use of healthcare system lower than expected

UCLA researchers find that Latinos in the U.S. illegally are 50% less likely to visit emergency rooms.

By Mary Engel
Los Angeles Times Staff Writer
November 27, 2007

Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.

The cost of providing healthcare and other government services to illegal immigrants looms large in the national debate over immigration.

In Los Angeles County, much of the focus of that debate has been on hospital emergency rooms. Ten have closed in the last five years, citing losses from treating the uninsured, and those that remain open are notorious for backlogs.

By federal law, hospitals must treat every emergency, regardless of a person’s insurance — or immigration — status. Illegal immigrants, who often work at jobs that don’t offer health insurance, are commonly seen as driving both the closures and the crowding.

But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.

“The current policy discourse that undocumented immigrants are a burden on the public because they overuse public resources is not borne out with data, for either primary care or emergency department care,” said Alexander N. Ortega, an associate professor at UCLA’s School of Public Health and the study’s lead author. “In fact, they seem to be underutilizing the system, given their health needs.”

Ira Mehlman, media director for the Federation for American Immigration Reform, a group that lobbies for tougher immigration controls, said that usage rates are just one measure of illegal immigrants’ effect on healthcare. The other factor, he said, is the cost to taxpayers, which Ortega’s study did not examine.

Cost estimates vary widely. A Rand Corp. study published last year in the journal Health Affairs put the cost of healthcare for illegal immigrants nationwide at $1.1 billion a year, excluding care for those younger than 18 and older than 64.

FAIR called the Rand number a “low-ball” estimate. Its own study of healthcare costs of illegal immigrants and their dependents, including U.S.-born children, estimated California’s portion alone to be about $1.5 billion a year.

Mehlman said $1.5 billion “is still a significant amount of money, unless you’re Bill Gates.”

Ortega’s study is not the first to find that illegal immigrants use fewer healthcare services than people born in the U.S. But his study used the largest sample, analyzing data from 42,044 participants of the 2003 California Health Interview Survey, a randomized telephone survey conducted by the UCLA Center for Health Policy Research and the California Department of Public Health.

And while other studies have attributed lower usage to immigrants simply being younger and healthier than the overall population, the study published Monday took into account age, health status, insurance status and poverty level. All such factors being equal, it found, immigrants still made fewer visits to physicians and were 30% less likely than U.S.-born Latinos to have a regular source of healthcare.

Dr. Felix Nuñez, a Los Angeles-based family physician and former medical director of the South Central Family Health Center, said the findings confirm what he sees in clinics.

Illegal immigrants are infrequent patients for primary care visits, he said, because being asked for ID cards, Social Security numbers and employment histories makes them nervous. They fear being reported to authorities, even though the information is used only to determine Medi-Cal eligibility or to set a sliding-scale fee.

What did surprise Nuñez was the relatively low use of emergency rooms by illegal immigrants.

“My gut would have told me that they’d be higher users of emergency services because they’re not coming in for routine, preventive care,” he said. “This kind of study is really important because it forces you to look at the data and rethink your assumptions.”

mary.engel@latimes.com

Access barriers for low-income families

Insurance + Access (does not equal) Health Care: Typology of Barriers to Health Care Access for Low-Income Families

By Jennifer E. DeVoe, MD, DPhil, Alia Baez, BA, Heather Angier, BA, Lisa Krois, MPH, Christine Edlund, MSc and Patricia A. Carney, PhD
Annals of Family Medicine
November/December 2007

This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.

Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs.

In summary, obtaining and maintaining insurance was the most important theme among all families. Comparing families in all insurance groups, insurance coverage issues were more often reported by families with uninsured parents or uninsured children. Access concerns were mentioned most often among those with public health insurance, whereas privately insured families more commonly mentioned unaffordable medical costs.

http://www.annfammed.org/cgi/content/full/5/6/511

Comment:

By Don McCanne, MD

This is yet another study of coverage, access and costs for low-income families. The findings are intuitive, not to mention having been supported by many other studies.

* For families with no coverage, obtaining insurance was their greatest concern.

* For families with public insurance such as Medicaid, access to care was their greatest concern.

* For families with private insurance, unaffordable medical costs were their greatest concern.

What does this mean?

For the uninsured, the consequences are obvious. In the event of medical need, being uninsured threatens both health security and financial security.

For those covered by public insurance targeted to low-income families, chronic underfunding remains a problem because of the lack of adequate political support for welfare programs. This results in a lack of willing providers, especially for specialized services. Thus access is a problem simply because the care is not available. Community Health Centers, if accessible, provide some basic needs, but cannot ensure access to more expensive, high-tech services.

For those with private insurance, health care costs remain a barrier to care. As this report states, “there is a growing number of low- and middle-income families with private health insurance who gain access to most services, but the high deductibles and co-pays prevent them from getting necessary care.”

The last statement above should concern us all. The financial barriers erected by private plans impact not only low-income families but also middle-income families as well. Yet most of the leading proposals for reform are based on a market of these private insurance plans. Lack of affordability is already a major concern, and it will only grow worse under these proposals.

The fact that this study indicated that public insurance causes access problems should not concern us since it represents a peculiarity of an underfunded welfare program – Medicaid. Our other public insurance program – Medicare – is funded at a level that assures an adequate number of willing providers, primarily because of continuing political advocacy for a popular program that eventually serves us all.

Medicare does have one problem that Medicaid does not, and that is excessive out-of-pocket cost sharing that creates affordability problems for some beneficiaries. But a new and improved Medicare for All, a single-payer national health program, would rectify that problem. Cost sharing that creates financial barriers to care would be removed.

We can have it all: health care that is universal, accessible and affordable.

Insurance payment confusion leads to bad credit reports

Why medical debts shouldn't count

For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.

By Liz Pulliam Weston
MSN Money
November 19, 2007

The Your Money message board is littered with complaints from folks whose otherwise pristine credit was sabotaged by a medical collection. Sometimes their records were besmirched over absurdly small amounts that nonetheless had big impacts on credit scores.

Medical collections are surprisingly common, at least according to a 2003 Federal Reserve study of consumer-credit reports. Nearly one in three consumers (31%) with a credit report had at least one collection account reported, and more than half of those were medical collections.

The amounts owed weren’t substantial: 36.5% of the medical collections were for $100 or less, and 86% were for $500 or less.

Yet any collection account is considered a major negative to lenders and to the credit-scoring formulas they use. Though the impact of a collection on your scores fades over time, it will shave off points for as long as the negative mark remains on your report — typically seven years.

Your chances of having your credit ruined by a medical bill are soaring for a variety of reasons:

* More people are uninsured or underinsured.

* Medical-debt collection has become big business.

* Medical billing is a mess.

Even when a consumer is covered by insurance, confusion abounds. Doctors and hospitals often insist the consumer is ultimately responsible for the bills, saying medical providers bill insurers only as a courtesy. Yet frequently the providers have agreements with insurers and government agencies to accept discounted reimbursement as payment in full; the providers aren’t supposed to pursue patients for payment.

Meanwhile, insurers are constantly changing what’s covered and by how much, and providers move in and out of covered networks. Providers also claim some insurers deliberately drag their heels on reimbursements, adding to the chaos and uncertainty.

“Insurance companies are often contributing to the false reporting of medical debt,” said (Travis Plunkett, a spokesman for the Consumer Federation of America), as tussles over payment increasingly get turned over to collection agencies.

http://articles.moneycentral.msn.com/Banking/YourCreditRating/WhyMedicalDebtsShouldntCount.aspx?page=all

Comment:

By Don McCanne, MD

So you have excellent coverage. About six months ago you received medical care for what proved to be a minor problem. The care included a couple of office visits, a few laboratory tests, medical imaging, two prescriptions, and you’re fine now.

Since then you’ve received numerous statements from your insurer documenting the physician visits, laboratory tests, medical imaging facility services, radiologist’s fee for interpretation of studies, and documentation from the pharmacy benefit manager. Each statement included many numbers, but the only number that really caught your attention was the dollar amount after the statement, “You are not responsible for paying this amount.” That appeared on several of the forms, though the amount noted was confusing since it didn’t seem to fit with any of the other numbers on the page. In the meantime, you have received statements from each of the medical professionals and health care institutions involved stating that your insurance has been billed and that this is the amount due (the total, non-adjusted charge), but since no payment yet appears you decide to wait until payment is actually made by the insurer and the disallowed amount is adjusted off. Otherwise you really don’t know what you should pay.

Within the past week, you have received notices from two different collection agencies representing two of the billing entities. Since your coverage is excellent, it is clear that there is some error here. What do you do?

The first step is to take out your insurance contract to see what is covered. Check for deductibles, copayments (dollar amount), coinsurance (percentage of the charges), tiering of benefits (different coverage for different levels of products or services), capping of benefits (maximum to be paid under specific categories), amounts to be paid by a fund such as a health savings account, and any other innovative features specific to your coverage. Then check to see if each professional and institution is contracted with your insurer. Since the list you have is a few years old, be sure to obtain a current list of providers. Then determine precisely how much is to be paid by the insurer, how much is to be adjusted off, and how much you are responsible for paying. The set of numbers will likely vary depending on whether or not the professional or the institution is currently contracted. Now retrieve from your records every notice of change in benefits that you received from the insurer at each annual renewal. Go back and change the numbers based on these notices, being certain that you apply the changes in chronological order.

Okay. Now that you’ve done this, you find that you do owe the amounts for which you are responsible after payments were made to the providers and the disallowed amounts were deducted. But the amounts demanded by the collection agencies are greater than the amounts that are your responsibility.

Since obviously there is an error, you now contact the administrative staff of one of the providers that are dinging you. The staff member insists that their ledger for your account is correct and that the insurer has obviously made an error. They don’t have time to help you further and insist that you contact your insurer since that’s your responsibility anyway.

After hours of punching through automated phone systems with endless times on hold, dropped calls, referrals to other departments, you finally end up where you began, and a real person in India tells you that all of their numbers are correct. She explains that the provider apparently did not adjust off the full disallowed amount, assuming, of course, that you did pay the deductibles and coinsurance that you owed. Oh.

So you call back the provider and explain that you will send payment for the deductible and coinsurance that you owe, but you want them to adjust off the balance that was disallowed. Sorry. The account has already been turned over to the collection agency and you will have to deal with them.

The collection agency responds by stating that they have nothing to do with insurance contracts. All they have is the amount that the provider turned over to them for collection, and that is the amount that you must pay. If you want an adjustment made, you’ll have to contact the provider.

Take a break from this one, and start the process over with the other collection agency. (Repeat the last six paragraphs here.)

Enough. Just pay the whole d*** thing and consider later whether to go through the grief of trying to obtain refunds from the providers. But at least this will keep your credit report clear. Sorry. These delinquencies have already been reported by both collection agencies. You can receive a free credit report if it’s been over a year since your last request, but you’ll have to pay a fee to find out how many points were deducted from your credit score.

What is really sad is that, with what you believe to be a really great health insurance plan, and with an honest effort to comply with the rules of your plan, and in spite of considerable personal inconvenience, you can become one of the more than 15 percent of individuals who end up with an impaired credit rating merely because of the administrative complexity inflicted on us by the private insurance industry.

With a single payer national health program, you go to your health care professional, receive your tests, and then follow the treatment program that you decide on after further consultation with your healthcare professional. The bills go to the single payer; you receive a statement of services and payments only to keep the process transparent.

Why are our politicians telling us that this isn’t politically feasible? Do we really want to continue to include screwed up credit reports on our list of the perverse features of an exclusively American health care system?

Do we really want to protect the thriving big business of medical-debt collection? After all, aren’t they merely an extension of the medical insurance administrative profession that we prize so highly?

Looking for a Bright Side

Republican and Democrat promote hospital coverage for all as Catamount fails Vermonters

By Peter Freyne
Seven Days: Vermont’s Independent Voice
11/21/07

Health Care Solved? — This month, the Vermont television airwaves are full of the well-done, funny ads with the farmer saying how he’s “healthy as a horse” — just before the horse behind him keels over!

The TV ads, centerpiece of a $1.6 million marketing campaign (http://www.greenmountaincare.org), were unveiled recently at Rutland Regional Medical Center by a bipartisan contingent that included Republican Gov. Jim Douglas, Democratic House Speaker Gaye Symington and Democratic Rep. Harry Chen, M.D.

The pitch is to get uninsured Vermonters over 18 who’ve been uninsured for at least 12 months to contact Green Mountain Care and sign up for the highly touted Catamount health insurance plan. That’s the one which was agreed upon by both the Democratic leadership under the Golden Dome, who surrendered on single-payer, and the best friend the insurance industry has in Vermont: Gov. Jim Douglas.

But Cambridge, Vermont, physician and health-care-reform firebrand Dr. Deb Richter doesn’t fool easily. Yours truly asked the good doctor recently for her take on what the state’s leading politicians are touting as progress.

“The governor is right, Catamount is a very good insurance product,” answered Dr. Richter. “And it will be wonderful for the few thousand people the state can afford to subsidize. But it won’t do a thing for the tens of thousands of Vermonters who are struggling to pay for health insurance policies that have huge co-pays and deductibles and barely cover their needs,” she added. “The Catamount solution is akin to putting a high-quality Band-Aid on a wound that is getting larger by the day. It won’t solve the problem. But it will get the governor re-elected. And that is the point, isn’t it?”

Richter doesn’t mince words. And she’s part of a growing body of medical doctors across the country who also want America to join the rest of the civilized world with regard to health care. They have an increasingly active national organization called Physicians for a National Health Program (https://pnhp.org). These docs share the “radical” notion with docs in France, Britain, Spain and Canada that “health care is a human right.”

Vermont’s health-care reform “Joan of Arc” was promoting Michael Moore’s illuminating film Sicko around the state this summer and fall. The other evening she brought the flick to a student audience at the University of Vermony. Good crowd turned out — almost 400.

When it was over Richter asked, “How many of you have health insurance?”

Almost all the hands in the theater went up.

“And keep your hands up if you have health insurance for life,” she added.

All but two or three hands dropped.

“See, that’s the problem,” said Dr. Deb. “Everyone in every other industrialized nation is guaranteed health care for life.”

But the “real” shame, noted this Vermont doctor, wife and mother of a college-age kid — and who does make house calls — “is that we’re already spending enough money in total to cover every single American with comprehensive coverage, eye care, dental care, prescriptions, doctor, hospital, everything!”

The audience of tuition-laden college folk was paying very close attention.

“You have to know a couple numbers,” said Richter. “Of the total amount we’re spending in Vermont, one-third of it is for administrative costs. It has nothing to do with health care. Not with people taking your blood pressure or doing any kind of surgery. You don’t need all these people in administration.

“Put it all in one pot and there’s more than enough money,” said the good doctor. “So this whole idea that we can’t afford to cover every single person in America is bullshit, and we should call it that!”

The audience burst into applause. Who doesn’t like a doctor who talks straight? In fact, Richter’s straight talk has prompted a few to suggest the candidate-strapped Vermont Left consider her as gubernatorial material in 2008.

Richter says she’s not interested. At least not at the moment.

So if there’s more than enough money to cover everyone, why isn’t everyone covered?

“You have to wipe out the insurance industry from health care. It’s a little bit of a problem,” she said with a tinge of sarcasm.

Yes, indeed.

Only in America, eh?

When it comes to your health, the middle man comes first!

The horse may topple over in the million-dollar Catamount TV ad campaign, but Dr. Deb isn’t giving up. Richter is organizing her troops behind H.304, a bill that would at least provide some hospital coverage to all Vermonters. A foot in the door, though not in the operating room.

The bill is sponsored by Barre Town Republican Rep. Topper McFaun and former Democratic Speaker of the House Michael Obuchowski of Bellows Falls.

Interesting duo, eh?

P.S. If you haven’t seen Sicko because you think you know what it’s about, do yourself a favor this holiday season. Rent it. Buy it. Sit down and watch it. Mr. Moore’s best by far.

Only in America.

Advocacy Group for Single-Payer

Mark Gruenberg, Editor
Press Associates
Union News Service

NEW YORK (PAI)–As the debate over the future of national health care heats up–at least among the Democratic presidential hopefuls–an advocacy group for single-payer government-run health care has published a leading medical scholar’s point-by-point criticism of the health care plans offered by the top three Democrats.

Not surprisingly, Len Rodberg, research director the New York affiliate of Physicians for a National Health Plan, concludes that the plans offered by Sens. Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.) and former Sen. John Edwards (D-N.C.) would be inferior to Canadian-style government-run national health care.

Single-payer government-run health care is drawing increasing grass-roots support among local unions and particularly central labor councils, even though the two union federations–the AFL-CIO and Change to Win–have taken no stand on exactly how to achieve universal health care coverage in the U.S.

Instead, both federations vow to put universal health care, type unspecified, atop the domestic agenda for the 2008 election, forcing candidates from both parties to take the issue on. The unionists would then decide, after the election, what method to back to achieve that goal. The AFL-CIO has not ruled out single-payer health care. Change to Win has taken no official position on any health care alternative.

Several leading unions, notably the Steel Workers, the California Association of Nurses, the International Longshore and Warehouse Union, the Auto Workers and at least one building trades union, support government-run single-payer health care.

By contrast, Andy Stern, president of the Service Employees–the union with the most health care workers–does not rule out single-payer but says it may well be politically unachievable.

Many of those unions endorse the single-payer bill (HR 676) offered by veteran Rep. John Conyers (D-Mich.). His district includes many Auto Worker retirees and present UAW members who see their health care benefits dwindle or in possible danger, while the not-so-Big-any-more-Three dumped health care on the union.

HR 676 would virtually extend Medicare and its government-run system to the entire nation, trashing the health insurance companies, their co-pays, denial of coverage and care, high premiums and the 18,000 yearly deaths they cause–according to government estimates–due to denial of payment for treatment of their policyholders. Insurers’ overhead now takes at least 20% of health care dollars, while Medicare’s overhead is 3%.

One of the other Democratic hopefuls, Rep. Dennis Kucinich (D-Ohio), is a lead co-sponsor of Conyers’ plan, but Rodberg’s analysis does not mention that.

In his critique, Rodberg makes several key points:

* In their details, none of the three leading Democratic hopefuls offer “universal” coverage. Rodberg points out Obama’s plan is universal only for children. The senator claims his plan cuts costs so much it would become universal for adults, too.

But Rodberg disputes that. He says none of the three plans cuts costs, because all three leave the insurers in place to run the system–with no cost controls.

* “Large employers must provide insurance for their employees or–in the case of Edwards and Obama–pay into a fund to subsidize insurance for their employees,’ Rodberg notes. But he says the plans are silent on minimum coverage requirements the insurers must meet, relying on “competition’ to produce improved health care coverage. That could produce minimal, Wal-Mart-like coverage at high cost.

Clinton, Rodberg noted, even used the health insurers’ phrase “American Health Choices Plan” as a label for her plan. That “suggests that what consumers want is a choice of plan,” not universal coverage, Rodberg added.

* Workers and their families would be forced to buy insurance individually, again without cost controls. Rodberg says the three hopefuls’ plans would offer “income-related subsidies through the tax system” to help those who cannot afford insurance.

* Insurers would be barred from rejecting people for pre-existing conditions and Clinton’s plan would also ban “large premium differences based on age, gender, or occupation.” But again there would be no cost controls, leaving insurers free to declare that they would insure certain people–the elderly and those who ‘cost’ more–at enormous prices, Rodberg states.

“Since multiple payers would remain–even if one of them might be a public payer (similar to Medicare)–few of the savings and simplifications that are possible with a single payer plan can be achieved,” he contends.

“Consumers must purchase insurance, but no limits are proposed on what insurers can charge them. No regulations are proposed to assure the adequacy of benefits or that would affect either the restrictions insurers now impose on the choice of doctor and hospital or the way they handle, and deny, claims.

“And there is no simplification of the complex and wasteful private insurance sys-tem with its co pays, deductibles, exclusions, and claim denials,” Rodberg ends.

###

Press Associates, Inc. (PAI) — 11/26/2007

Former Brooklin, Maine Couple Applaud Canadian System

by Tom Walsh
The Ellsworth American
Thursday, November 22, 2007

BEAR RIVER, Nova Scotia — Along the stretch of Nova Scotia highway that leads to Paul and Gretchen Volenik’s new home is a road sign that reads “Paradise, Next Right.”

The Voleniks are convinced that’s exactly where they have settled.

“We love it here,” Paul says. “This area is like Maine was 35 years ago. We’re just delighted every day that we are here.”

Last spring, after first moving to Nova Scotia in 2005, the Voleniks put down permanent roots in the picturesque village of Bear River, an artists’ colony not far from Digby.

Now living near Digby, Paul and Gretchen Volenik are enjoying all that rural Nova Scotia has to offer, including tax-funded medical care.

Through “Bear River Bargains & Books,” Paul, 59, sells old books and other collectibles, while Gretchen, 56, devotes her attention to expanding the garden she’s designing for self-sufficiency.

For Paul the cross-border move came after 35 years of living in Maine, the last nine in Brooklin. Between 1994 and 2002, he served as a Democratic state representative in the Maine Legislature.

Until term limits pulled the plug on his political career, Volenik was a tireless and vocal advocate for a state-funded universal health care system that would provide health insurance and medical care to every citizen of Maine.

That never happened. Ironically, as permanent foreign residents of Canada, the couple now have access to universal health care through Nova Scotia’s tax-funded medicare program, a system that provides cradle-to-grave, unlimited access to medically necessary health care services.

“Paul worked very hard over eight years in the Maine legislature, fighting to get health care for everybody,” Gretchen says. “Now we have it. It wasn’t our intention that it would just be he and I, but we do have it now. And it’s too bad that Maine, and the United States, doesn’t have it.”

Paul Volenik said he’s studied the issue of single-payer universal health care long enough to know its doable in Maine. What’s lacking, he feels, is the political will to scrap the existing multi-payer system, with its well-entrenched special interests eager to protect the profits inherent in the status quo.

“Through what was known as the Health Security Board, we did the most advanced study in the country on single-payer health care systems,” he said. “The report that came out said that we could keep the current system of private delivery of health care but with totally public funding, folding in all of the health care dollars coming into the state, including Medicare.

“By adding a payroll tax, we could cover everyone in the state with not Cadillac coverage, but good, basic coverage — better than most insurance policies — for less money than was currently being spent in Maine on the total cost of health care. And that was keeping the private delivery system. We didn’t propose going as far as Canada, which is not just publicly funded, but involves publicly owned hospitals and, in some places, doctors on salary. We didn’t go that far, but we did prove we could cover everyone for less money.”

As governor, Angus King Jr. threatened to veto any single-payer legislation, Volenik said.

When Governor John Baldacci took office, he embraced the Dirigo approach, which Volenik described as an “incremental” system that doesn’t confront the issues that keep driving up the costs of medical care and health insurance.

“The Baldacci system and any of the other incremental systems that have failed in the past is like a train,” Volenik said. “The engineer is driving the health care train, and he stops at each stop and picks up a few more people, maybe children, or a group of low-income people. But he fails to notice that the train is on fire and that people are leaping off in all directions, because the system is ridiculous.

“An incremental system doesn’t work,” he said. “Until you get rid of the insurance companies, until you get rid of the immense power of the drug companies, until you get rid of the inflated salaries of hospital administrators, you will never have an effective health care system.”

Paul and Gretchen Volenik don’t have a family doctor. The Digby region, like other rural areas within Nova Scotia, is enduring a shortage of doctors. Fortunately, they said, they don’t need a doctor.

“We don’t have a physician; we have a nurse practitioner, and it’s the best medical care I’ve ever had,” Paul says. “Instead of, like in Maine, going into the office for an annual physical and having the doctor see you for 10 or 15 minutes, every time I’ve seen her she’s spent at least an hour, with real interaction as to your total medical situation.”

Gretchen said both she and Paul have also required services provided through a small hospital located 17 miles from home in Annapolis Royal.

“Although we continually hear about wait times, we have not experienced that at all,” she said. “When we went to Halifax to have physicals to become permanent residents, I figured we’ll be there all day long, and that didn’t happen.”

Gretchen realizes the system isn’t “free,” that hefty income, sales and other taxes cover the $2.8 billion annual cost of providing health care services to Nova Scotia’s 935,000 residents. She says she doesn’t mind paying more than $4 a gallon for gasoline because she knows that fuel taxes help pay for Nova Scotia’s health care system.

“It’s a fair way to do it,” she said. “Everybody pays those taxes. We all pay into it. It’s not like the wealthy get the good health care, and the working stiff gets some kind of health care, but with big deductibles. And then there are the people who can’t get health care. There are all these tiers in the United States. Here, it’s the same for everybody, and we all pay.”

Giuliani and Health Care

The New York Times
Letter to the Editor
Published: November 24, 2007

To the Editor:

Re “Giuliani, Foe of ‘Socialized’ Medicine, Expanded Public Care as Mayor” (news article, Nov. 17):

As The New York Times reported on May 3, 1996, Mayor Rudolph W. Giuliani appointed former Mayor John V. Lindsay to two largely ceremonial city posts to provide Mr. Lindsay with city-financed health insurance and make him eligible for a pension. Although Mr. Lindsay belonged to the upper class all his working life, the cost of his health care had driven him into dire straits in retirement.

Mr. Giuliani saw nothing wrong with enlisting socialized health insurance to rescue an old friend, an approach that Mr. Giuliani, as presidential candidate, now deplores as “socialized” medicine.

The term applies to systems in which the government not only finances health insurance, but also owns and operates all health care facilities. The system at the Department of Veterans Affairs reserved for military veterans, for example, is purely socialized medicine.

If Mr. Giuliani despises socialized medicine, as he now contends, perhaps he would abolish the V.A. health system if he were elected president. American veterans should challenge him to come clean on the issue.

Uwe E. Reinhardt
Princeton, N.J., Nov. 17, 2007

The writer is a professor of political economy at Princeton University.

Promote Universal Single-Payer Health Care

The California Democratic Party
Resolution Number ANA07.15

WHEREAS, California is facing a major public health crisis due to the skyrocketing costs and diminishing benefits of the current health care system resulting in 7 million uninsured and countless underinsured Californians; and

WHEREAS, the 25 percent or greater cost that the private health insurance system spends on the administration of health plans makes apparent the inefficiency of this system in contrast to the less than 3 percent it would cost to administer a “single-payer” “Medicare-type” insurance system; and

WHEREAS, the California Democratic Party is already on record as endorsing the move toward a “single-payer system” as stated in the 2006 CDP Platform, as well as being on record as endorsing a universal health care proposal that covers all state residents through a non-profit, single payer, comprehensive health plan;

THEREFORE BE IT RESOLVED, that the CDP recognizes that the health and well-being of Californians is not a commodity to be subjected to the demands of the free market, and the profiteering of stockholders and CEOs; and

BE IT FURTHER RESOLVED, that the CDP strongly supports the drafting and passage of legislation that creates and enacts a single-payer health care program which provides comprehensive, secure, high quality, efficient and sustainable access to health care for all Californians.

Submitted and Written by: Johanna Olson, MD, So. California Chair,
California Democratic Party Progressive Caucus, DSCC Member, 42nd AD
Co-sponsored by: Susie Shannon, Executive Board Member, 42nd AD

Signatories: Ahjamu Makalani, DSCC Member, 61st AD;
Helen Hartman, DSCC Member, 42nd AD;
Brad Parker, DSCC Member, 42nd AD; John Heaner, Region 13 Director;
Dante Atkins, DSCC Member, 42nd AD; Marilyn Grunwald, DSCC Member, 40th AD;
Dan Licht, DSCC Member, 42nd AD;
Michael Jay Miltenberg, DSCC Member, 42nd AD

#

Adopted by the Executive Board
Of the California Democratic Party
At Its Executive Board Meeting
Sheraton Hotel, Anaheim
November 18, 2007

A Word about SCHIP

by Andrew D. Coates
Monthly Review
November 2007

The recent proposal, vetoed by President Bush, to expand the State Children’s Health Insurance Program (SCHIP) represents an important effort to defend working families with uninsured children from the grim cruelty of paying out of pocket for the care of sick children, which can too easily lead to financial ruin for the entire families and create impediments, at least, to medical care for the children.

American health care is in crisis, and yet we are still putting coins and dollars into humble jars and coffee cans at diner counters, supermarket bake sales, and church fundraisers to try to raise money for the treatments of uninsured children afflicted with malignancies. (Charity exists in America, but only for children who never did anything to anyone and who, even from the most conservative, fundamentalist, neo-liberal, or Malthusian viewpoint, could never be said to deserve their illnesses.) Haven’t we all wondered at one time or another: what if we find ourselves among those parents who can’t find the money or time off work when their child needs to see a doctor or a dentist? And what if the doctor said that more tests are needed, or a specialist, or a hospital? What kind of society do we live in that produces, so readily, such personal desperation when a child becomes sick?

The SCHIP program not only promises to address this appalling situation by reducing the number of uninsured children but should cost society relatively little since children in America are by and large healthy and require, compared to older people, fewer expensive treatments, hospitalizations, and interventions. So (like the 84% in the New York Times poll earlier this year) we can all agree that SCHIP should be expanded to include ALL of the roughly 9 million children in America who have no health insurance.

But what can we, who are serious about health care reform, expect from SCHIP? Some characterize SCHIP as a step toward universal health insurance. Would that it were so.

Launched in 1998, SCHIP gives a block grant to states to fund programs to either augment Medicaid benefits to children, or establish a separate subsidized health insurance for children, or do some combination of these two. The program did help to reduce the number of uninsured children until 2004. However, the number of children losing private employer-based coverage has progressively outstripped enrollment in SCHIP. Since 2004, the number of uninsured children has risen dramatically, by more than 1 million children, through 2006. Yet the SCHIP expansion proposal, introduced by Congressman Rangel (HR 976), did not aim to cover all children. It hoped to provide funds to cover 3.2 to 4.2 million children by 2012 — fewer than half of children who lack health insurance now.

Thus, this SCHIP expansion, even if enacted, would still fall short of meeting all the unmet needs as private health insurance fails ever more children than before. So one step forward, one step back.

Worse, SCHIP is a capped grant given out state by state, so not only does its delivery vary widely from state to state, but funding for the children now covered by SCHIP has lagged behind the skyrocketing costs of health care, creating a crisis in many states. More realistically, then, one step forward, two steps back.

Therefore, it’s misleading to call the SCHIP expansion proposal a step toward universal health insurance. The proposal should be vigorously supported, but, at the same time, we should explain that SCHIP, a laudable social reform that has protected many families from ruin, does nothing — absolutely nothing — about the cause of the burgeoning number of uninsured children: the fact that our system is dominated by private employer-based health insurance.

Reforms that rely on private health insurance, including those that set up publicly-financed insurance alongside the existing system (as SCHIP does), will simply not work. They will be brought down by the harsh realities of health care bought and sold as a corporate commodity, which does not provide health security and is becoming less and less affordable each day: soaring costs at every level, widening disparities in access and outcomes, lack of choice of provider or clinic or hospital, and deteriorating quality of care. Proposals for health reform that avoid this fundamental issue may mitigate the inhumanities of our health care system, but they will not get us out of the crisis.

So what should we do?

Even as we support the expansion of SCHIP, we must make clear what created the urgent need for a program like that to begin with: the failure of private health insurance. In other words, in struggle for SCHIP, activists must lay the groundwork for reform that offers a true step forward — a proposal for a publicly-financed single-payer national health program, like House Bill HR 676.

The past record of private health insurance corporations has disqualified them from continuing as the central force managing American health care. If mainstream politicians lack the courage to say so, they are out of step with the American people, who now recognize that private insurance has got to go — in a democracy, the public should decide health policies.

Democratic candidates question reform proposals

Obama Criticizes Rivals on Health Care

The Washington Post
November 21, 2007

“When Senator Clinton or Senator Edwards say they’re going mandate health care, but they haven’t talked about either how to enforce it, or how to make it affordable to people, then it’s not really a mandate. Anymore than if we mandate that people get car insurance. But (if) they can’t afford it, they just don’t get it,” (Sen. Barack) Obama said.

“Senator Clinton’s health care plan covers every single American. Senator Obama’s does not. Any health care plan that leaves 15 million Americans uninsured cannot be considered universal,” said (Clinton spokeswoman Kathleen Strand).

http://www.washingtonpost.com/wp-dyn/content/article/2007/11/21/AR2007112101034.html

And…

Bill Richardson Talks Up Health Plan

Associated Press
November 21, 2007

Speaking at Rivier College, which offers nursing degrees, (Gov. Bill Richardson of New Mexico) said he isn’t completely opposed to the kind of government-run, single-payer system used in Canada and many European countries, but prefers to give consumers a choice.

“I’m starting to warm up to it a little bit because I get very frustrated with insurance companies. … They tick me off, and I wish I could say, ‘You’re out of this business,'” he said. “The problem with that is, fundamentally, I believe every American deserves choice.”

Richardson said he’d rather control the insurance companies and force them to do the right thing. He also said he worries that a single-payer system would create an overwhelmingly complex bureaucracy.

“I hate bureaucracy,” he said.

“If you hate bureaucracy, how can you like HMOs and insurance companies?” Richard Ingram called out from the audience.

“That’s called a left hook,” Richardson joked.

http://ap.google.com/article/ALeqM5gNrYvAi-WwpRBCdw1Ry9fxZ2as4QD8T1O61G0

Comment:

By Don McCanne, MD

There seems to be a consensus that the Democratic presidential candidates are leading on the issue of health care reform. But what are they leading with?

Except for Dennis Kucinich who advocates for a single payer national health program, all of the candidates support choice in the private health insurance market (albeit some would also include a competing public insurance program that would fail due to adverse selection). The well-recognized fundamental flaw of using private plans is that the insurance industry can no longer provide reasonably comprehensive plans that are affordable for average-income individuals (without resorting to near-fraudulent underinsurance programs).

Sen. Clinton ignores this and pretends that you can simply require individuals to buy bona fide plans that they cannot afford. Sen. Obama does acknowledge this problem but pretends that tweaking our system will make plans so affordable that everyone will want to buy them. Neither approach can possibly provide affordable, comprehensive care for everyone. By rejecting the single payer approach of creating an equitably-funded universal risk pool, they have both abandoned any hope of achieving affordable health care for everyone even before the real process for reform has begun.

Gov. Richardson also uses the conservative/neo-liberal framing of “choice” (phony choice of private marketplace health plans that take away your real choices in health care) because of concerns about political feasibility of the progressive framing of “choice” (real choice of health care professionals and facilities under a universal, publicly-financed system). But he does seem to understand the line between politics and policy as he let slip his actual views about single payer, and about the private insurance industry about which he wishes he could say, “You’re out of this business.”

And his comments about hating bureaucracy? Maybe it’s time to give all of the candidates a left hook – not a knock-out blow, but just enough to shock them into reality.

Candidates propose opportunities for private insurers

Health-Care Plans Aid Industry

By Laura Meckler
The Wall Street Journal
November 19, 2007

Democratic presidential candidates like to beat up on insurance companies, but there is a lot for the industry to like in their health-care plans — starting with plenty of new business.

“Here’s the potential for a whole new pool of lives for them to cover, with payment behind it,” said Benjamin Isgur, assistant director of PricewaterhouseCoopers’ Health Research Institute, which examined the presidential health plans’ impact on industry. The study, a comprehensive look at health-care plans offered by candidates in both parties, also concludes that doctors, hospitals and other health-care providers would likely benefit since more patients with insurance suggest more would seek care and be able to pay their bills.

The industry’s chief lobbyist, Karen Ignagni, president of America’s Health Insurance Plans, says she is encouraged by the debate so far and says her group is focused on trying to get universal insurance enacted rather than stopping it.

http://online.wsj.com/public/article/SB119543898597597588-hAX1Z6ys2bagmXahn8UDxuEhGQ0_20071219.html?mod=tff_main_tff_top

And…

Beyond the Sound Bite

Review of Presidential Candidates’ Proposals for Health Reform

PricewaterhouseCoopers’ Health Research Institute
November 2007

The seven leading Republican and Democratic presidential candidates are proposing two different approaches that would reform the U.S. healthcare system at two different speeds. The Democrats promise broader and more immediate changes, with new mandates, programs, and funding. Rather than creating new government programs, the Republicans’ proposals rely on indirect approaches such as changes in tax incentives that could move insurance away from an employer-based model.

None of the leading candidates are proposing a single-payer system; therefore, the industry’s future hinges on a public/private system.

Ensuring that 100% of U.S. residents have access to insurance coverage is probably not realistic, but a mix of solutions is more likely to achieve higher levels of coverage because the uninsured defy a common stereotype.

The market for individual insurance, which has seen minimal recent growth despite the introduction of tax-advantaged health savings accounts (HSAs), could receive a boost through the Republicans’ tax credits or the Democrats’ proposals to require individuals to buy health insurance.

The chief concern for health plans is to protect the markets in which they sell their products. While increased coverage would benefit health plans, they could see major changes in how they sell their products. Within the candidates’ proposals are three key risks for insurers: new regulation on companies, especially community rating and profit limits; possible loss of entire markets to government insurers; and possible movement of market share as products shift from employer to individual market.

Full report (65 pages):
http://pwchealth.com/cgi-local/hregister.cgi?link=reg/soundbite.pdf

Comment:

By Don McCanne, MD

All proposals of the leading Republican and Democratic candidates for president would use various tax policies to increase funds available for the purchase of private health plans, especially in the individual market. Does this really provide greater opportunities for private insurers to expand their markets and increase their revenues?

The stumbling block is the apportionment of risk. Will the plans be required to open their risk pools to higher-cost individuals with greater health care needs? Or will they be allowed to continue to select out the healthier sectors and pass the real costs on to the government (taxpayers)?

If they must include all risks, their products would be affordable only if regulations would permit the sale of underinsurance products, making actual health care access unaffordable for many. On the other hand, if they were allowed to decline to cover higher-risk individuals, then they would continue to be an expensive, superfluous industry that shirks their most important function of pooling risk.

Of course, there is the risk that private insurers could lose “entire markets to government insurers,” but isn’t that what they really want? Keep the healthy, but shift the high-risk individuals to government programs? If that were the case, then shouldn’t we adopt principles of social insurance similar to those of other nations with universal systems that use private insurers?

Under such programs, common pools of sickness funds are established, or inter-pool transfers are arranged based on actual claims experience. That way the private plans would pay their fair share of total health care costs. But then their premiums wouldn’t be affordable.

It’s time to give up on the fantasy that the insurance industry can provide us with affordable comprehensive plans when we expect them to participate in the pooling of risk.

We don’t need policies that would expand markets for the private plans. We simply need to establish a common, universal risk pool and fund it equitably. With our own public system, we wouldn’t even need the private plans.