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Uninsured by choice?

Uninsured by choice?

Hispanics Push Texas to No. 1 in Uninsured Residents

By Jason Roberson
Hispanic Business
August 29, 2007

Texas again ranks No. 1 with the highest percentage of uninsured residents in the nation — primarily due to the state’s growing Hispanic population, according to a report issued Tuesday by the U.S. Census Bureau.

Because of their low wages, many Hispanics have to set priorities, said Jaime Martinez, co-chairman of the health commission for the League of United Latin American Citizens, the country’s oldest civil rights group for Latin Americans.

“They would rather put money on the table, pay the light bill, pay the rent, than buy insurance that’s very costly,” Mr. Martinez said. “That’s why we need to address the health care of the uninsured and underinsured in this country.”

The National Center for Policy Analysis, a conservative Dallas-based research group, said a growing number of households are uninsured because they want to be.

“Whether it be cultural or a matter of economics, for a growing number of households being uninsured is a matter of choice,” said Devon Herrick, a senior fellow of the NCPA.

Bill McCormick, a 55-year-old computer systems analyst from Richardson, is an example.

“I am not Hispanic and I don’t have medical insurance,” Mr. McCormick said in response to Tuesday’s news. “That was the choice I made … drop the medical insurance or go hungry.”

The NCPA is fighting the move for a single-payer, government-run health care system, saying a free-market system is best.

http://www.hispanicbusiness.com/news/newsbyid.asp?id=75135&cat=Headlines&more=/news/more-news.asp

Comment:

By Don McCanne, MD

As anticipated, the opponents of comprehensive reform are framing the increase in the numbers of uninsured as a matter of personal choice for many.

Does their outspoken insensitivity to the unmet health care needs in this nation really resonate with the public? If not, then why doesn’t our compassion translate into action?

On Life Support

By Arian Campo-Flores
Newsweek.com
web exclusive
May 9, 2007

Dr. Arthur Kellerman couldn’t believe what he was hearing. He had just begun a fellowship assignment with the House Committee on Oversight and Government Reform in January when staffer Karen Nelson invited him to attend a briefing on Capitol Hill. Dennis Smith, director of the Center for Medicaid and State Operations, would be discussing a planned rule change by the Bush administration. “Don’t say anything,” Nelson told Kellerman. “Just listen.” At the meeting, Smith said that the rule was simply an attempt to rebalance federal and state roles in financing Medicaid. But when he explained the details, Kellerman could barely contain himself. As Kellerman understood it, the rule would result in millions of dollars in funding cuts for hospitals across the country. “I’m hearing this and having a heart attack,” he recalls. Nelson and others strafed Smith with questions and the briefing came to a close. But a new battle between Congress and the administration had begun.

It was a sobering start for Kellerman, 52, whose regular job is chairman of the Department of Emergency Medicine at the Emory University School of Medicine. For years, he’s been sounding the alarm that hospital emergency rooms nationwide are in crisis. The stats are disconcerting: while visits to emergency departments increased by 26 percent from 1993 to 2003, hospital beds plummeted by 198,000, and 425 ERs around the country shut down, according to a 2006 report by the Institute of Medicine, a nonprofit arm of the National Academy of Sciences. Kellerman has experienced the impact firsthand at Atlanta’s Grady Memorial Hospital, which is partly staffed by Emory doctors. Burdened by a growing pool of uninsured patients and squeezed by funding cutbacks, the institution is teetering at the edge of an abyss. Yet despite Kellerman’s efforts to spur officials at all levels to action, Grady’s condition has only grown worse. Part of the challenge: talk of ERs at the breaking point has become so familiar that it’s hard to convey a sense of urgency. So last September, Kellerman headed to Washington, D.C., after winning a prestigious yearlong Robert Wood Johnson health- policy fellowship. He landed a spot working for the oversight committee now chaired by Democratic Rep. Henry Waxman, who’s concerned about emergency-care issues and has taken on the Bush administration with zeal. Over the past nine months, NEWSWEEK spent time with Kellerman in both Atlanta and Washington, as he journeyed from a blood-soaked ER to the antiseptic corridors of power.

When he started his fellowship, Kellerman heard the same advice repeatedly: don’t expect to accomplish anything substantive in a year; just come to learn. But of course, he says, “we all try to make a difference anyway.” He had no shortage of ideas. Last year, he concluded his work on an Institute of Medicine committee that took a comprehensive and probing look at the state of emergency care in the U.S. The resulting series of studies, published last June, painted a despairing portrait, but also offered a raft of recommendations. Given the approaching midterm elections, Congress and the administration did virtually nothing. But after the Democratic takeover, Kellerman imagined things might be different.

The administration’s planned Medicaid rule change, however, dashed those hopes. Kellerman realized this was no time for lofty ambitions; Congress would have to play defense. The rule, scheduled to take effect on Sept. 1, deals with the arcane world of Medicaid financing. Two provisions in particular dismay many in the health-care field. One limits states’ ability to tap certain funding sources to meet their Medicaid obligations. The other stipulates that Medicaid reimbursements cannot exceed the cost of treating the Medicaid patient. While that provision may sound reasonable, says Larry Gage of the National Association of Public Hospitals, it doesn’t account for the harsh reality confronting medical facilities that treat large numbers of the uninsured. Since these facilities don’t get reimbursed for that treatment, they rely in part on higher-than-cost Medicaid reimbursements. As a result of the new administration rule, many hospitals may need to make drastic cuts in personnel, beds and more. “There isn’t any question that if this regulation goes into effect in the ways it’s proposed, there will be reduced safety-net services in many communities,” says Gage, who considers the rule “the most important legislative or regulatory issue that we’re confronting right now.” Smith, the Medicaid official, whose center is part of the Department of Health and Human Services, responds that it defies logic to reimburse more than the cost of care and that state governments need to step up to meet their obligations. Smith argues further that some hospitals have abused the Medicaid financing system in the past–a point that even Gage concedes (although he maintains that the abuse problem has largely been eradicated).

The administration calculates that the rule change will reduce federal Medicaid expenditures by about $3.8 billion over five years. But Gage and others estimate the impact on hospitals will be much larger. At Grady, where 42 percent of revenue comes from Medicaid, Kellerman estimates that the hit could total $200 million over five years. “Grady is already struggling,” he says. “This would put it out of business.” Were Grady to close, the consequences would be far-reaching: the hospital is the only Level I trauma center (the highest designation) in a 120-mile radius of Atlanta, and one quarter of Georgia’s physicians are trained there.

In the wake of the rule announcement, lawmakers and lobbyists leapt into action. Waxman and others wrote a letter in March to the secretary of the Department of Health and Human Services, urging that the rule be withdrawn. At a time when the nation is at risk of a terrorist attack, they argued, the ERs on the front lines are more crucial than ever; yet hospitals can barely cope with the routine traffic on a Saturday night. More than 150 House members from both parties signed the letter (Kellerman helped round up signatures, shuttling from one congressman’s office to another). But the administration refused to budge. So lawmakers turned to another tactic: they inserted a provision in the Iraq supplemental-funding bill that would impose a one-year moratorium on implementing the rule. Though Bush vetoed that bill, many lawmakers are intent on including the same provision in the next attempt to craft an Iraq-spending measure. They seem to have plenty of supporters. In the oversight office, Kellerman sifted through about 450 responses to the rule sent by individuals and groups during the public comment period. “They ranged from negative to overwhelmingly hostile,” he says.

Waxman now has a new plan to press the administration: an oversight committee hearing that will be held around mid-June, the one-year anniversary of the Institute of Medicine reports. Though the main purpose is “to examine the federal government’s failure to address the crisis in emergency care,” as he puts it, the new Medicaid rule will surely come up as well. Kellerman is now helping prepare for that hearing. He worries that if the administration manages to implement the rule, it may attempt other federal funding cuts that Bush has mentioned in his budget proposals. “It’s hard to imagine congressmen will just allow hospitals in their home districts to get wrecked,” says Kellerman. But as he has learned, Washington’s ways–its partisan politics, its backroom dealing–can be confounding. All he can do is continue to hammer home the message of what’s at stake. “Either we’ll figure it out and start addressing [emergency care] in a serious manner,” he says, “or the system will fail catastrophically.” Kellerman has sounded such alarms before to little avail. Now, though, he’s got a slightly bigger megaphone.

(c) 2007 Newsweek, Inc.

Guest Opinion: U.S. needs to wake up and provide universal health care

Ray Clasen
The News Press
Fort Myers, Florida
September 04, 2007

I’ve reckoned that if I did not have health insurance, the annual physical exam I receive at my family doctor’s would cost, including blood work, over $500. Without insurance I couldn’t afford these physicals, but without them my high blood pressure would still be undiagnosed, and I’d be a walking medical time bomb, a stroke waiting to happen.

Isn’t it ironic that the wealthiest nation on the planet is also the only “developed” nation that does not provide some sort of universal health care plan for its citizens? Forty-five million Americans do not have health insurance. As The News-Press pointed out in June, one in four Southwest Florida residents lives without coverage.

Some of these people are probably in good health, but many are in urgent need of medical attention and drugs they can’t pay for. This situation is a national disgrace and needs immediate attention. We must make it clear to the current crop of presidential hopefuls, be they Democrat or Republican, that health care reform must be their most important domestic issue.

Forget the hodgepodge of ideas that have been floated in different states on this issue; the only solution to this problem that makes sense is a single-payer universal health system administered by the federal government, a sort of Medicare for everyone. The argument that the government cannot be trusted to efficiently administer such a plan is ludicrous. The government already effectively runs Social Security and Medicare. Other large governments, for example Canada and Great Britain, administer universal health care programs, and do so quite efficiently.

Frankly, I’ll trust the government before I’ll trust a private entity that’s driven by greed.

Equally ludicrous is the argument that a single-payer government-run system will lead to rationing, an argument often repeated by President Bush. I’ve got news for the president: we already have rationing, and being denied health care because of an inability to pay for it is the most insidious form of rationing.

Those of us who have health insurance have no reason to be complacent on this issue. Skyrocketing premiums are forcing employers to consider dropping their coverage for employees entirely or making employees take on an ever greater share of premium costs. Larger deductibles and ruthless HMOs mean that health insurance is increasingly just a hedge against bankruptcy. It doesn’t take a catastrophic illness anymore to cause a family to be thousands of dollars out of pocket, even though they have health insurance.

It isn’t difficult to figure out why our political leaders are so reluctant to try to solve our health care crisis. Look what happened to Hillary Clinton when she tried to run point on some relatively modest reforms in 1992. The health care and pharmaceutical industries spent millions in a campaign to frighten the public into accepting the status quo, and it worked. And they’ll do it again. These industries are some of the biggest donors to the campaign coffers of our politicians and expect support in return. It will take a president of enormous courage and resolve to tackle this problem, but the problem must be tackled.

In Europe, even in Cuba, access to quality health care is considered a basic right of every citizen, not a privilege of the fortunate who work for good companies or are wealthy enough to buy insurance. It should be so in the USA. No American family should have to use the local ER for their family doctor. No American should be denied medical treatment because of an inability to pay for it. No American should have to choose between filling a needed prescription and paying utility bills.

I lived in Britain for some years and am familiar with their National Health Service. Are there problems with their version of “socialized medicine?” Yes. Waiting rooms can be crowded. Doctors and nurses are often overworked and feel underpaid.

There can be waiting periods for non-emergency procedures. But no one in Britain is worried that a catastrophic illness is going to drive their family into bankruptcy. No one ever worries about being denied medical attention or being unable to fill a prescription.

There are few issues that are literally a matter of life and death. The status quo on health care in this country is beyond unacceptable, and we need to make this clear to our presidential candidates and congressmen. It’s sad to think that the nearly $2 trillion wasted in Iraq could have provided the basis for universal health care here in America. We need to get angry and proactive on this issue.

— Ray Clasen lives in North Fort Myers.

Private Finance Initiative Costs British NHS Billions

This great free-market experiment is more like a corporate welfare scheme

A hospital in Coventry lays bare the deceit of neoliberal logic: staff cuts, ward closures and millions to the financiers

George Monbiot
The Guardian
Tuesday September 4, 2007

After my column last week, several people wrote to point out that the neoliberal project – which demands a minimal state and maximum corporate freedom – actually relies on constant government support. They are, of course, quite right. The current financial crisis, caused by a failure to regulate financial services properly, is being postponed by government bail-outs. The US federal reserve has reduced its lending rate to the commercial banks, while the Bundesbank organised a €3.5bn rescue of the lending company IKB. This happens whenever the banks suffer the consequences of the freedom they demand. But over the past week an even starker example has emerged.

In Britain the split loyalties of the major political parties have created a hybrid system of public provision. If it left public services intact, the party in power would be roasted by the corporate media, but if it attempted full-scale privatisation, it would be booted out of office. So the last Conservative government devised a plan that would keep both sides if not exactly happy, then at least totally bewildered. They called it the private finance initiative, or PFI. Corporations would build and run our schools, hospitals, roads and prisons, and rent them to the state. This, the Tories maintained, would enable costs to be cut, while ensuring that public services remained free of charge.

At first Labour opposed this scheme. Alistair Darling warned in opposition that “apparent savings now could be countered by the formidable commitment on revenue expenditure in years to come”. But as the 1997 election approached, Labour sought to prove that it was more sympathetic to business than the Tories were. Two months after the party took office, the health secretary, Alan Milburn, announced that “when there is a limited amount of public-sector capital available, as there is, it’s PFI or bust”. From then on, the only money the NHS could rely on for capital projects belonged to the private sector.

The problem was that much of what the NHS wanted to do was not attractive to private financiers. In Coventry, for example, it had been planning to refurbish its two hospitals at a cost of £30m. But its analysts realised that business would not be interested. The scheme was too small, and there was no scope for the financial innovation that could produce serious profits. As a confidential report by the local health authority showed in 1998, the health service redesigned its scheme to make it more attractive to private capital. Instead of refurbishing the two existing hospitals, it would ask private business to knock them down and build a new one – the University hospital. This would cost not £30m but £174m. The health experts who wrote the confidential report predicted that in order to find this money, the hospital trust would have to cut both beds and services. They have just been proved right.

Did I say £174m? I beg your pardon. By January 2002 the price had risen to £290m. A month later it reached £311m. By the end of that year it had grown to £330m. In 2003 it was estimated at £370m. In March 2007, the Birmingham Post reported that the final cost was £410m. This year the hospital trust must find £56m, covering repayments and service fees, to hand to the private consortium. The annual cost will rise in line with the retail price index for 30 years.

It is now pretty obvious that this fee is unpayable, if the hospital is to maintain a proper standard of care. Over the past few days the hospital trust has announced a £30m hole in its budget. Around £10m of the necessary cuts could be found by making staff redundant: it will lose perhaps 200 people, possibly 375. It will also rely on “revenue generating activities”. These include charging people £3 for dropping their sick relatives outside the hospital, and £10 for parking there, while cancelling the free parking scheme for disabled people. As the new hospital is on the edge of the city (against the wishes of 160,000 people who signed the Socialist party’s petition to have it built in the centre), which means that it is hard to reach without a car, this is an effective way of raising money. But it casts doubt on the government’s claim that the NHS remains free at the point of use.

The hospital trust’s press officer told me that this cost-cutting is a unique event: “We have always balanced our books up to this year.” But in 2005 – the year in which the PFI payments began – a leaked memo revealed that the trust was anticipating a deficit of £13m by the end of the financial year, and “drastic measures” were required to plug the gap. These included the closure of one ward, the removal of eight beds from another, limiting the opening hours of the surgical assessment unit and the “rationalisation of certain posts”: which meant, eventually, cutting 116 jobs.

In 2006 the local newspaper reported a shortfall of £29m. This was met partly by freezing the recruitment of district nurses. In January this year, the hospital announced that it was closing another ward, just six months after it had opened. Yet another ward – where people with acute conditions such as pneumonia and strokes were treated – was closed in June. The impact of these cuts is already being felt: three months ago the new hospital found itself in the bottom 10 in the national league table for waiting times. Where will the money come from over the rest of the 30-year PFI contract?

There is one set of costs the hospital cannot cut: the money it must pay every year to the private financiers. In September 1997 the government declared that these payments would be legally guaranteed: beds, doctors, nurses and managers could be sacrificed, but not the annual donation to the Fat Cats Protection League. The great free market experiment looks more like a corporate welfare scheme.

The government justifies all this by claiming that privately financed schemes are cheaper than comparable public schemes. Allyson Pollock showed on these pages in April that the data required to support this claim does not exist, or if it does the government refuses to release it. But as the Coventry scheme shows, there’s an even bigger deception at work. The government compares the cost of building the hospital under PFI with the imagined cost of building it with public money. But it would not have been built with public money. If public funds had been available, the two existing hospitals would have been refurbished, at around one 13th of the cost.

It was Gordon Brown who insisted that PFI became the principal means of funding capital projects in the United Kingdom. By deferring costs into the future, as Darling warned, he was able to sustain his reputation as an iron chancellor, while suppressing the constant baying of the corporate press. The BBC predicted that in his speech yesterday Brown would announce a reduction in the corporation’s involvement in the public sector. It was about the only subject he did not discuss. For all his talk of “listening and engaging”, corporate power still seems to be forbidden territory.

ACS campaign on health insurance

Cancer Society Focuses Its Ads on the Uninsured

By Kevin Sack
The New York Times
August 31, 2007

In a stark departure from past practice, the American Cancer Society plans to devote its entire $15 million advertising budget this year not to smoking cessation or colorectal screening but to the consequences of inadequate health coverage.

The campaign was born of the group’s frustration that cancer rates are not dropping as rapidly as hoped, and of recent research linking a lack of insurance to delays in detecting malignancies.

The two 60-second television commercials that form the spine of the campaign make that point.

One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.”

The other commercial depicts a young mother whose family has gone into debt because her insurance did not fully cover her cancer treatment. “Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.

Census figures released this week show that the number and percentage of people in the United States without health insurance rose last year, to 47 million and 15.8 percent. A 2003 study estimated that one of every 10 cancer patients was uninsured.

Other surveys have found that one of every four families afflicted by cancer, which is projected to kill 560,000 Americans this year, is effectively impoverished by the fight, including one of every five with insurance.

John R. Seffrin, the chief executive of the cancer society, which is based here, said his organization had concluded that advances in prevention and research would have little lasting impact if Americans could not afford cancer screening and treatment.

“I believe, if we don’t fix the health care system, that lack of access will be a bigger cancer killer than tobacco,” Mr. Seffrin said in an interview. “The ultimate control of cancer is as much a public policy issue as it is a medical and scientific issue.”

http://www.nytimes.com/2007/08/31/us/31cancer.html?_r=2&hp=&oref=slogin&pagewanted=all

Comment:

By Don McCanne, MD

The message of the American Cancer Society is clear. The most important single measure that would improve access to care that could save lives would be to provide everyone with comprehensive health insurance.

Coverage alone is not enough. The growth in innovative private plans that compete based on the premium charged are rapidly expanding the rate of underinsurance, thereby creating financial hardship for those insured individuals who develop cancer (or other major diseases or injuries).

Reform proposals that build on our current system of financing care are dependent on a dramatic expansion in the use of these inadequate innovative plans. What a cruel policy recommendation. A mother should never have to let her cancer go untreated merely because feeding her children is a higher priority.

Good public policy, such a comprehensive national health insurance program, saves lives. Bad public policy, such as encouraging underinsurance in the private market, kills.

The dark side of healthcare reform

By Benjamin Day
The Boston Globe
August 30, 2007

AFTER EXTENDING healthcare coverage to more than 150,000 previously uninsured residents over the past year, Massachusetts health reform took a turn for the worse this month with the Patrick administration’s proposal to limit the state’s Free Care Pool.

The Free Care Pool exists to catch those who fall through the cracks of both private and public insurance programs, by reimbursing hospitals and health centers that treat the uninsured without any of the cost barriers — premiums, copayments, deductibles — that leave low-income patients with medical debt, or worse, untreated illnesses and conditions. The administration’s reforms would refuse eligibility for this safety net to everyone who is eligible for the state’s subsidized health plan, Commonwealth Care, along with anyone offered “affordable” insurance by their employer. The proposal would also, for the first time ever, impose cost sharing — deductibles and copayments — on many of the exclusively low-income patients who rely on the pool for medical care they can receive nowhere else.

In public hearings and consultative sessions hosted by the administration, not a single organization representing Massachusetts patients or residents agreed with this change. What rapidly emerged was a chorus of grassroots protest from legal advocates, patient support groups, labor, communities of faith, policy experts, doctors, hospitals, and health centers. It is easy to understand why Governor Patrick’s move to hobble the health safety net lacks a popular base of support: Last year, more than 450,000 people benefited from Free Care Pool coverage.

Why would Patrick, under the guise of a law designed to expand access to healthcare for everyone, cripple the state’s only program that guarantees that low-income, uninsured residents have a place to land when all else fails? The answer from administration officials is this: a safety net that is too effective at catching people when they fall through the cracks is incompatible with the the state’s new health plans. Almost all of those who have been added to the healthcare rolls under the reform law have come in under fully subsidized, free-coverage plans that don’t require premium payments. The partially subsidized plans, on the other hand, as well as those plans residents must purchase at full cost, haven’t exactly been flying off the shelves.

This is clear evidence that the standards for what people can afford to pay under the new law are wildly unrealistic. But state officials implementing the law argue that the existence of a working safety net may be discouraging enrollment. Commonwealth Care representatives have commented publicly that the Free Care Pool must be made less attractive.

There is a long and unfortunate history to this line of thinking, which has led to the erosion and, at times, the vilification of our economic safety net institutions. From the Work Relief programs of the Great Depression through Welfare to Workfare, attempts to erode income security have been proposed as a way to corral the unemployed into the workforce. In the United States, the only developed nation without a national universal health plan, the health safety net is targeted as a means of corralling the uninsured into traditional insurance plans.

There is little evidence that eroding safety net programs actually helps improve participation in the labor market or the healthcare market. This does, however, succeed in punishing the poor, throwing low-income communities back on their own resources, and increasing the stigma upon safety net recipients. In the case of the new health law, this is a particularly meaningless and insulting exercise, as the law itself provides stiff financial penalties for any who are deemed able to afford health insurance but fail to enroll in a public or a private plan.

In 2008, the state penalty for being uninsured will be more than $1,000 per year, exceeding the fines for virtually all criminal violations on the books including violation of the child labor laws (a $50 fine) and domestic assault (a maximum $1,000 fine). And a person will still be uninsured after paying it.

The nation today is looking to Massachusetts. Are we as a society willing to use our neighbors’ health as an additional stick to punish them for deciding they can’t afford the state’s “affordable” premiums? I hope not.

Benjamin Day is executive director of Mass-Care: The Massachusetts Campaign for Single Payer Health Care.
(c) Copyright 2007 Globe Newspaper Company.

The moneylenders move in

Doctors Offering No-Interest Loans to Patients

By Milt Freudenheim
The New York Times
August 30, 2007

Zero-interest financing, a familiar sales incentive at car dealerships and furniture stores, has found its way to another big-ticket consumer market: doctors’ and dentists’ offices.

Of course, going into debt to pay for medical procedures is nothing new for many people.

But as the price of health care continues to rise and big lenders pursue new areas for growth, this type of medical financing has become one of the fastest-growing parts of consumer credit, led by lending giants like Capital One and Citigroup and the CareCredit unit of General Electric.

Big insurers, too, are devising new financing plans with various payback options. Upstart players have also aggressively cut deals with doctors.

The room for expansion looks ample, as rising deductibles, co-payments and other costs may force more of the nation’s 250 million people with health insurance to finance out-of-pocket expenses for even basic medical care.

“As more and more of the costs of care are shifted to consumers, people are going to need more credit,” said Red Gillen, a senior analyst at Celent, an insurance and banking research firm. “They are still going to need health care.”

The zero-interest plans are not for everyone. In fact, they are available only to the creditworthy — meaning they offer no help to those among the nation’s 47 million uninsured who are in difficult financial situations.

Even for those who can get credit approval, the plans make sense only if users are able to make payments on time and close the loan on schedule, typically within 12 months. Otherwise, the loans after defaults can carry interest rates of 20 percent or more — similar to the default penalty on a typical credit card.

Some consumer debt experts warn that as more people try to bridge widening gaps in their health insurance, paying for medical care on credit could plunge the unwary into a financial crisis. In recent years, the use of high-interest credit cards to pay big medical bills has become a leading cause of consumer bankruptcy.

Still, consumer credit companies and some insurers are now experimenting with financing plans meant specifically for medical costs.

For people who think they could not pay off a zero-interest loan within a year, most credit companies also offer longer-term medical financing deals with 12 percent to 13 percent interest payable over several years. Those plans, though, must be arranged at the outset of the medical expense; a zero-interest plan typically cannot be converted to the longer-term program if consumers find themselves unable to pay off the one-year loans.

Some insurers, including UnitedHealthcare, also have special credit plans available for insured members whose policies are linked to health savings accounts. Such policies combine high-deductible insurance with tax-sheltered savings accounts where money can roll over year to year until needed for medical expenses. But typically, the amounts of money being set aside do not go very far toward meeting even routine health expenses.

So far, among the 1.76 million health savings accounts in this country, the average balance is $1,327, according to a recent survey by Inside Consumer-Directed Care, a trade publication. To help people with health savings accounts meet the shortfall, the Exante Bank unit of UnitedHealth Group is trying out a card that extends credit at rates currently averaging about 10 percent to 13 percent, depending on the applicant’s credit history.

As for the zero-interest deals, the credit providers say that most of them end up being just that — interest-free. About 80 percent of the medical loans that CareCredit provides are paid off on schedule and incur no finance charges, according to the company’s president, Michael J. Testa.

That, the companies say, justifies the high default interest rates for late payments, since that is the way they recoup the costs of doing business. In fact, though, the credit companies make money even on the interest-free deals, because they are typically keeping 10 percent of the fee the doctor charges the patient. But for patients with low credit ratings, a (provider) eager to build a clientele might have to accept as little as 75 percent of the bill.

http://www.nytimes.com/2007/08/30/business/30medloan.html?_r=2&hp=&oref=slogin&pagewanted=all

Comment:

By Don McCanne, MD

More rhetoric from the marketplace.

Are these interest-free loans really free? Not when your complicit health care provider gives your cash discount of 10 percent to 25 percent to the moneylender, and you pay rack price. And it’s especially not free when one late payment throws you into an exorbitant default rate.

And if ever you had visions that the health insurers might be interested first and foremost in your welfare, and only secondarily in improving their business models, this should lay that thought to rest. Your billfolds and purses are no longer enough. They now want your bank accounts too.

Models of reform that build on our fragmented system dependent on private health plans will only further compound the problem of medical debt. The moneylenders will become yet one more powerful vested interest that will continue to block reform.

A couple thousand years ago, a very fine Gentleman turned over the tables of the moneylenders. Where is He now when we really need Him?

Poll shows more Californians favoring single-payer health care

Tom Chorneau
San Francisco Chronicle
Sacramento Bureau
Wednesday, August 22, 2007

(08-22) 04:00 PDT Sacramento — – As voter dissatisfaction with the state’s health care system grows, increasing interest is emerging in moving to a state-run, single-payer program, according to a Field Poll released today.

For years, a single-payer system had been the favorite of a small but loyal minority, but the new poll shows that 36 percent of California voters now favor replacing the current employer-based system with one operated by the state – a jump of 12 percent since December.

Meanwhile, the number of voters who want to make reforms within the framework of the current system has dropped from 52 percent in December to 33 percent in August.

“This is a clear signal that people want change,” said Anthony Wright, executive director of Health Access, a Sacramento consumer group that supports both a single-payer proposal and legislation aimed at reforming the current system.

“What you have here is two-thirds of California saying they want a major expansion of group coverage,” he said. “People are looking for reform, and they want the government to make the system fair.”

The poll findings were drawn from telephone interviews with 536 randomly selected registered voters during the 10-day period ending Aug. 12. It has a sampling error of plus or minus 41/2 percentage points.

Mark DiCamillo, director of the Field Poll, said there’s a strong relationship between voters being dissatisfied with the current system and their interest in alternatives.

“The message from the governor and legislators that the system is broken has sunk in,” he said. “Back in December, people had a mixed view of the system and were less interested in change.

“Now we have more people with a very negative viewpoint.”

In December, DiCamillo pointed out, the poll found 51 percent of voters were satisfied with the way health care worked in California, with 44 percent dissatisfied.

Today, only 28 percent said they are satisfied with health care in California and 69 percent are dissatisfied. He also noted that the number of voters who said they are very dissatisfied has more than doubled since December – from 20 percent to 42 percent.

While the numbers give supporters of single-payer a boost, advocates of less-drastic change said voters will not support a government-run system.

“There’s no question that people continue to be concerned about the high cost of health care and are worried about getting and keeping insurance,” said Vince Sollitto, spokesman for the California Chamber of Commerce. “But turning over health care to the same government that brought you the Department of Motor Vehicles and the post office isn’t the way to go, and most Californians agree with that.”

Chuck Idelson, spokesman for the California Nurses Association, which is a strong supporter of a single-payer system, said the Field Poll findings are similar to recent national polls that show growing support for single-payer.

“People want real reform, not phony reforms,” he said.

The Field Poll also found growing voter skepticism that the Legislature and Gov. Arnold Schwarzenegger will come to an agreement on a health care overhaul this year – 58 percent said it was unlikely.

Schwarzenegger introduced a $12-billion plan in January aimed at covering all Californians, but he’s made little progress in selling it to the Legislature.

The governor’s plan relies on sharing the cost of coverage extensions to 6.5 million uninsured residents within the existing system – an approach that has lost support among voters since December, according to Field.

Schwarzenegger spokesman Aaron McLear said the poll numbers show that Californians overwhelmingly see the need for health care reform. “As we educate the public on the merits and problems of single-payer, we are confident that our proposal will be supported,” he said.

E-mail Tom Chorneau at tchorneau@sfchronicle.com.

Canadian care costs less, insures all citizens and could help cut U.S. poverty, crime rates

By David Karwacki
The Salt Lake Tribune
08/10/2007

(Editor, Salt Lake Tribune: The writer is addressing the question, “Should the U.S. use Canada as its model for health-care reform?”)

SASKATOON, Saskatchewan – Americans set their sights admirably high by seeking a Jeffersonian guarantee of life, liberty and the pursuit of happiness.

Advances in medical science and technology, especially diagnostics and pharmaceuticals, can certainly help them achieve those goals – if they can afford them. Many millions, unfortunately, find their life, liberty and happiness threatened because of illness and a lack of access to even basic, let alone advanced, medical care.

Access to universal medical coverage was introduced in my province of Saskatchewan in 1962 and was adopted by the federal government to apply to all Canadians in 1964.

Instead of life liberty and the pursuit of happiness, Canada’s constitution stresses “peace, order and good government.” We believe that government can be a force for good and in some areas – public health care being one – and can actually do a better job than private corporate interests.

For more than 40 years Canada’s Medicare has improved the quality of life for tens of millions of people, liberated them from the threat of unaffordable medical bills and made it easier for them to pursue their own definition of happiness.

Our Medicare system isn’t perfect, but then neither is democracy. We don’t think that’s reason enough to get rid of them. Besides, there’s more than just a political “feel-good” reason for embracing universal health care. It’s good for business.

I’m the owner of a company in Canada and another in the United States that distribute fresh produce around the globe. My Canadian company has three corporate advantages over my U.S. company and our U.S. competitors: healthy workers, lower operating costs and better worker safety through social cohesion.

In my experience, healthy workers are more productive because they take less sick time than those who don’t, or can’t afford, to take care of their health. Lack of health-care access is a barrier to preventive care. Those who ignore early symptoms of an illness because their credit cards are maxed-out end up being less productive and may have to leave the work force. Then the employer faces the expense of training replacement workers.

The Organization for Economic Co-operation and Development estimates that total health expenditures in Canada amounted to 9.9 percent of GDP in 2004. In the United States it was 15.3 percent. And even though Americans spend more on health care, their life expectancy is, on average, two years less than Canadians.

Many U.S. companies enjoy a competitive edge in technology because of the R&D of the military industrial complex. In Canada it’s our single-insurer health-care system that provides us with a competitive advantage.

My U.S. company pays, on average, a premium of $9,300 per year for each employee to provide just basic medical insurance. My Canadian firm pays no premium. The costs are paid out of taxes and from resource royalties.

High health-care costs in the United States have been cited as one very big reason for what some people are calling “the outsourcing of America.” Witness the steady decline of the domestic auto-manufacturing sector.

Finally, I would argue that universal health care provides a social cohesion and increases our general security by helping to lift people out of poverty. A healthy population with access to health care is more likely to be productive and beneficial to the community. The rates of violent crime in Canada have yet to reach even a shadow of what is happening in America.

The economic reasons for universal medical coverage are clear. Just as important, however, is what Medicare says about our country and its people. We believe in the principle that everyone should have access to reasonable health care. That way life, liberty and the pursuit of happiness is for all of us – not just those who can afford it.

DAVID KARWACKI is the leader of the Liberal Party www.saskliberal.ca in the Canadian province of Saskatchewan and a distributor of fish and produce.

Middle-income losing coverage

Middle-Class Americans Join Ranks of Uninsured in 2006 as Private Coverage Shrinks

Physicians for a National Health Program
August 28, 2007

The U.S. Census Bureau released data today showing that the number of uninsured Americans jumped by 2.2 million in 2006 to 47.0 million people, with nearly all the increase (2.03 million) concentrated among middle-class Americans earning over $50,000 per year, according to an analysis by Physicians for a National Health Program (PNHP). (The median household income in 2006 was $48,200).

“Middle-income Americans are now experiencing the human suffering that comes with being uninsured. It makes any illness a potential economic and social catastrophe,” said Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and Associate Professor of Medicine at Harvard Medical School.

Physicians for a National Health Program noted the following:

* The 2.18 million rise in the number of uninsured is the biggest jump reported by the Census Bureau since 1992.

* There are now more uninsured in the U.S. — 47.0 million — than at any time since passage of Medicare/Medicaid in the mid-1960’s.

* 93% of the increase is among middle and high income families:

Of the 2.18 million increase:

1.398 million (64% of the increase) was in >$75k family income
An additional 633,000 (29% of the increase) was among $50-$75k group

Among full time workers, the number of uninsured increased by 1.230 million (56.4% of the increase).

The doctors’ group said that the only solution to the rising number of uninsured and underinsured is a single-payer national health insurance program, publicly financed but delivered by private doctors and hospitals. Such a program could save more than $400 billion annually in administrative waste, enough to provide high-quality coverage to all and halt the erosion of the current private system.

https://pnhp.org/news/2007/august/middleclass_america.php

Comment:

By Don McCanne, MD

The public welfare programs continue to putter along. The dramatic decline in coverage has been primarily in employer-sponsored plans. Therefore it is no surprise that most of the 2 million plus individuals who lost coverage in 2006 were in the middle and upper-middle income sectors.

This Census Bureau study did not attempt to assess the explosion in the rate of underinsurance. The September issue of Consumer Reports states that “43 percent of people with insurance said they were ‘somewhat’ to ‘completely’ unprepared to cope with a costly medical emergency over the coming year.”

The health insurance crisis is no longer simply a welfare issue for low-income individuals. It is now a looming crisis for middle-income America, the majority of us.

We can provide comprehensive care to everyone without spending more than we already are. And the polls do indicate that there is a distinct trend towards greater recognition that a national health insurance program is precisely what we need.

But where are the politicians? In an almost unified voice they have responded to this report by supporting insurance that would cover a portion of lower-income children (SCHIP). Covering more children is certainly a good thing, but isn’t that a pretty feeble response?

Kucinich is right on healthcare

By Derrick Z. Jackson
Boston Globe Columnist
August 29, 2007

DENNIS KUCINICH rarely gets much airtime in Democratic presidential debates. That was underscored recently when ABC’s George Stephanopoulos called on him in an Iowa forum to talk about God. Kucinich said, “George, I’ve been standing here for the last 45 minutes praying to God you were going to call on me.”

With poll numbers at 1 or 2 percent, the Ohio congressman is the nudge kicking at the knees of the Democratic Party to offer more than incremental change. He deserves more attention than he gets. On healthcare, he says what Americans believe, even as his rivals rake in contributions from the industry.

In a CNN poll this spring, 64 percent of respondents said the government should “provide a national insurance program for all Americans, even if this would require higher taxes,” and 73 percent approve of higher taxes to insure children under 18. Those results track New York Times and Gallup polls last year, in which about two-thirds of respondents said it is the federal government’s responsibility to guarantee health coverage to all Americans.

Such polls allow Kucinich to joke that, far from being in the loony left, “I’m in the center. Everyone else is to the right of me.” More seriously, in a recent visit to the Globe, he accused the other Democratic candidates of faking it on healthcare reform.

“One of the greatest hoaxes of this campaign — everyone’s for universal healthcare,” Kucinich said. “It’s like a mantra. But when you get into the details, you find out that all the other candidates are talking about maintaining the existing for-profit system.”

Kucinich quoted the 2003 study published by the New England Journal of Medicine that found that 31 percent of healthcare expenditures pay not for actual care but for administrative costs. That compares with only 16.7 percent in Canada. Administrative and clerical employees make up 27 percent of the healthcare workforce in the United States, compared with 19 percent in Canada.

“With 46 million Americans without any health insurance at all and another 50 million underinsured,” Kucinich said, “isn’t it really time to look at the other models that exist that are workable for all the other industrialized nations in the world? When you think about it, the only thing that’s stopping us is the hold that the private insurers have on our political system . . . corporate profits, stock options, executive salaries, advertising, marketing, the cost of paperwork. . .”

The hold of the healthcare industry on the top candidates is already apparent. According to the Center for Responsive Politics, the top recipient of campaign contributions so far from the pharmaceutical and health products industry is Republican Mitt Romney ($228,260). But the next two are Democrats Barack Obama ($161,124) and Hillary Clinton ($146,000). The top recipient of contributions from health professionals is Clinton ($990,611). Romney is second at $806,837, and Obama third at $748,637.

The top recipient of cash from the insurance industry, which includes health insurers, is another Democrat, Connecticut’s Christopher Dodd, at $605,950. Romney and Republican Rudolph Giuliani are second and third, with Clinton and Obama fourth and fifth. Even though Obama is in fifth place, he still has collected $269,750 from insurance companies.

In a category that is relatively small in money thus far, but huge in terms of healthcare morality, Democratic presidential candidates occupy four of the top six spots in receiving money from death-dealing tobacco companies. After Giuliani’s $69,500 from tobacco companies, Dodd has received $45,400, Clinton $32,300, Romney $31,400, Obama $7,885, and Democrat Joe Biden, $4,000.

When the top Democratic candidates take tobacco contributions, it is hard to see them truly believing, as Kucinich says, that healthcare “is the single-most important domestic issue. . . a defining issue in the presidential race.”

The top recipient from lobbyists by far is Clinton at $406,300. She is still so badly smoldering from the torching of her healthcare efforts as first lady that she recently asserted to the National Association of Black Journalists, “I have never advocated socialized medicine. That has been a right-wing attack on me for 15 years.”

The irony, as Kucinich critically points out, is that Americans are so burned from for-profit healthcare, that they want the government to guarantee coverage. “If people clearly understood that by going to vote on Election Day they would create conditions where they would have health coverage,” Kucinich said, “if you could communicate that message, you wouldn’t have to talk about anything else.”

'Profit equation': Health-care plan should not be financially motivated

Terry Gossard
The Charleston Gazette
August 28, 2007

The pursuit of profit has always been the principal motivating driver that sustains the American economy. Few would argue this because it strives to provide an economic lifestyle essential to America’s work force, small businesses and large corporations and the overall viability of local, state and federal government. However, the delivery of basic health care to all Americans should be removed from the “profit equation” at least as we relate it to the corporate bottom line.

Implementing a single-payer (universal) health-care system for all Americans is long overdue. It is a basic right of citizenship. Any attempt to hasten the dialogue in this regard has invoked the instant wrath of the universal health-care naysayers. Over the years, we have stood idly by and allowed the status quo barriers to become much more formidable than need be. The time is now to attack the real and imaginary barriers with fresh innovative thought as to how best achieve a viable single-payer system.

Rather than bow to naysayer resistance, it’s time for a full-court press. The longer we hesitate, the longer we continue to hesitate. To paraphrase Hedda Haning’s remarks in an Aug. 12 Sunday Gazette-Mail commentary, we as Americans are no less capable of developing a national health-care plan than the many other industrialized nations around the world who have already done so with a high degree of success.

A single-payer system would naturally be a quantum change in the way our health care is delivered, but not an impossible change. How would it work? How would it be managed? How do we bring the key parties to the table? How would it be funded? It would require a dramatic shift in the paradigm of health-care delivery and payment. The precedent has been established with the likes of Canada, France and Great Britain among others. Certainly we can find a way to model that which has performed well for those countries in their respective systems and improve upon those aspects which have not.

Opposition forces have thus far relied on rhetorical “scare tactics” to protect the status quo. The primary risk to the opposition would be any action taken that may result in a reduction of profit. For many of us who have experienced the denial of medical service or medication, or the unreasonable delay in providing timely medical decisions, or at the very least, health-care coverage that is less than satisfactory, do you really believe that our well-being is of paramount concern to those overseeing the full spectrum of insured services? How many of us (having any form of paid medical coverage today) can honestly say that we’re confident that our insurance company or third-party provider has our health-care interest at heart? Premiums, co-payments and deductibles continue to increase each year yet we must still fight for our medical needs. Unfortunately for many, waging these battles becomes far too exhausting or they’re simply not equipped to challenge the status quo.

Health-care decisions must be made solely by health-care professionals, pure and simple. Each and every insurance company and third party provider has a phalanx of front-line clerical personnel programmed with a checklist of “reasons” why your claim is to be denied or that the surgery ordered by your doctor is unnecessary or that medication “A” prescribed by your doctor is not right for you and that you should be using medication “B.” The fox has been in charge of the henhouse far too long.

We should not let allow inertia to be our albatross. A well-thought-out single-payer health-care system is well within our ability to define and implement. It won’t be an easy challenge; nor should it be. Yes, the barriers are formidable but not insurmountable. We deserve much better as a nation. As we approach the 2008 congressional and presidential election, we need to closely scrutinize the proposed health-care position put forth by each candidate and allow that to be a critical factor in guiding our voting decision. We must be persistent and vocal. Our voice will be heard at the ballot box.

There is a quote from the late Robert Kennedy that is perhaps befitting our challenge: “There are those who look at things the way they are and ask why … I dream of things that never were and ask why not?”

Gossard, of Charleston, is a retired supply chain manager from Union Carbide and Dow Chemical.