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Health care: The best won't be the easiest

Health care: The best won't be the easiest

Saul Friedman
Newsday
April 21, 2007

As we’ve discussed, “Medicare for All” may seem the simplest and most logical path to universal health care. But the nation’s conservative traditions and the entrenched multizillion-dollar for-profit health care establishment will be formidable obstacles on that path.

It took 20 years of political struggle to get Medicare, and it passed only because an overwhelmingly elected Democratic president, Lyndon Johnson, had veto-proof majorities in both houses of Congress. Such one-party control is not the case now, nor will it be after 2008, unless there is a political earthquake.

Thus, any proposal for universal health care will have to reckon with the combined power of the nation’s richest and most powerful lobbies – the insurance industry and drug manufacturers, as well as medical professionals who make out well in the current system. People are easily fooled by misleading ads. Remember the insurance lobby’s “Harry and Louise”?

My mail shows that while most Americans say they favor publicly supported universal health care and social insurance, including Medicare and Social Security, a vocal minority strongly believes that would lead to socialism or worse. The minority will be aided by a network of right-wing think tanks that never supported Medicare but helped kill the Clinton plan in 1994.

Every Democratic presidential candidate favors one form or another of universal health care. Along with several Republican governors, they have proposed what they believe is a more politically palatable path than Medicare for All – a combination of public and private health insurance. They would mandate that individuals buy insurance and, if necessary, raise revenues to subsidize those purchases.

Most of the more pragmatic proposals reject the single-payer approach, fearing it would run afoul of lobbying campaigns against centralized government control of health care. The latest proposal, called AmeriCare, comes from one of the most liberal members of Congress, Rep. Pete Stark (D-Calif.). Like most others, it would depend on private, for-profit insurance companies to provide health care for the non-elderly.

Even AARP, which earned $379 million in royalties in 2005, mostly from health insurance sales, appears to favor universal public and private health care coverage. AARP endorsed and makes millions from Part D, which is based wholly on private coverage. Last month’s AARP Bulletin reported on various state schemes for universal private coverage, but made only passing mention of the Medicare for All proposals in Congress.

The most comprehensive public-private proposal favored by some liberal groups has come from Yale political scientist Jacob S. Hacker. Writing for the liberal Economic Policy Institute, Hacker said he seeks “to avoid the dismal fate of previous reform campaigns” that ran afoul of budget problems, public resistance to change and “the embedded realities of the present system.”

His proposal, Health Care for America, would “extend insurance to all non-elderly Americans through a new Medicare-like program and workplace health insurance…. Every legal resident of the U.S. who lacks access to Medicare or good workplace coverage would be able to buy into the ‘Health Care for America Plan,’ a new public insurance pool modeled after Medicare….Employers would be asked to either provide coverage as good as this new plan or make a relatively modest payroll-based contribution to Health Care for America.

“It would not eliminate private employment-based insurance….It is not single-payer – a vision that, for both political and budgetary reasons, is unlikely to be achieved in the near future. Nonetheless, Health Care for America does embody many of the key virtues of a universal Medicare-like program.”

Hacker’s plan would put private insurance in competition with a Medicare-type plan to provide coverage that would be guaranteed. “Health Care for America,” he writes, would provide “a generous package of benefits…greater choice.” (See epi.org for the full text of Hacker’s proposal.)

Diane Archer, former president of the New York-based Medicare Rights Center, applauded the proposal as a way to create competition between public and private insurers, and predicted that for-profit insurers would not compete because “they would still try as hard as possible to avoid insuring the people with the costliest conditions.”

President George W. Bush, who opposes government involvement in health care, says universal coverage should be provided only by private insurers. Under his recent proposal, government would grant people more tax incentives – greater deductions – to buy health insurance, perhaps through their employers.

But many of the 45 million workers who are uninsured don’t pay enough taxes to benefit from any deductions. Many cannot afford insurance for themselves and their families, and others can’t qualify because of adverse medical histories.

While the president opposes government health insurance for others, he and his immediate family, including his mother and father, have benefitted most of their lives from government-supplied, taxpayer supported health insurance. And they’ll never be without that coverage. They (as well as Vice President Dick Cheney and members of Congress) earned it with government service. If government coverage is good enough for them, what about the rest of us?

The most cogent criticism of the plans offered by Hacker and several governors came in an editorial by the Des Moines Register. It said that requiring the purchase of health insurance, called “individual mandates,” through employers or subsidies, “is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate.”

Noting that a Register reader who bought an AARP-endorsed plan for $700 a month ended up with $200,000 in bills when he was treated for cancer, the editorial said, “Our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage.”

Copyright 2007 Newsday Inc.

Incremental Health Reform: Whose Life Doesn't Count?

by Rose Ann DeMoro
The Huffington Post
04.11.2007

Listening to the purveyors of conventional wisdom, you might think only an incremental approach on healthcare reform is possible.

The most comprehensive reform, HR 676 in Congress, (and its state versions, such as SB 840 in California), providing guaranteed healthcare as an expanded and improved Medicare for all, is not politically feasible.

So, the pundits insist, settle for what we can get.

Lower the expectations and turn down the public heat, they advise. Gradualism – extending health coverage to some – is the mantra of the day, fawned over by some politicians and advocacy groups alike. The staged appearance of “bi-partisanship” or “strange bedfellows” for health reform is often the only purpose of grand pronouncements of support for universal health care. Whether the proposals actually solves the health care crisis is irrelevant or secondary to the hype.

Virtually all the gradual reforms being touted would reinforce a dysfunctional system with as many standards of care as there are dollars to purchase them. It would further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.

For the proponents of political expediency, the question remains who will be left behind while we wait?

Every year, 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health coverage.

Among those un-covered, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment. Heart attack victims are less likely to receive angioplasty. People without pneumonia are less likely to receive X-rays or consultations. Those with colorectal cancer are 70% more likely to die within three years.

The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care (drugs and surgical interventions). Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and one third of credit card debt.

The public is fed up, and they’re ahead of the politicians and policy wonks. A New York Times/CBS poll last month found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.

As the polls show, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, provides one of the best arguments against incremental steps. When Medicare was enacted 42 years ago, following a broad grassroots campaign, many believed the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

Similarly, incremental healthcare reforms in Maine, Massachusetts, Minnesota, Washington, Vermont, and Tennessee, that were supposed to lead to universal coverage failed to produce any real reduction in the number of uninsured.

Moreover, by pushing further away the day of real reform, we open the door to some of the worst alternatives, from the Bush administration tax schemes to the current fad of forcing everyone to buy insurance.

Both of these schemes end up saddling people with high deductible insurance plans that more and more people are finding accelerate the healthcare crisis.

In January, a vice president of the Kaiser Family Foundation testified to Congress that one in six privately insured adults have “substantial problems paying their medical bills.” And, a new study this week by Harvard Medical School researchers in the Journal of General Internal Medicine documented that the financial burden of such plans is especially onerous for women who typically need more routine medical visits than men, and thus bear double the out-of-pocket costs.

It’s time to stop promoting inferior approaches and insist on real reform.

American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well.

Un seguro médico, para todos, de por vida

Jaime Torres
El Diario
OPINIóN – 04/24/2007

En toda la nación el tema de la crisis en nuestro sistema de salud está candente y la gente está demando a los políticos que la resuelvan. Hay 47 millones de personas sin cobertura médica — 14 millones son hispanos — y más de 50 millones con seguros inadecuados. El Instituto de Medicina reportó que cada año 18,000 personas mueren por falta de cobertura médica.

En salud, los EE.UU. gastan por persona más que cualquier otro país avanzado (casi el doble de Canadá y Francia). Aun así, tenemos la más alta mortalidad infantil y casi la más baja expectativa de vida del mundo desarrollado. Es muy claro que hay mucho sufrimiento y que las propuestas para “mejorarlo” en recientes años han tenido poco resultado.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para curar una úlcera en un pie; he peleado con aseguradoras por denegar procedimientos necesarios, y he visto niños recibir cuidado deficiente porque tenían Medicaid–un seguro que muchos ven de segunda clase. Es increíble que en el país más rico del mundo haya tanta injusticia y dolor.

Pero los demás países desarrollados brindan atención de salud a todos. La única razón que no tenemos cobertura universal es la espectacular ineficiencia de nuestro sistema. Aunque los EE.UU. gastan $2 trillones en gastos de salud, $600 billones nunca llegan a la gente, pero se usan en gastos administrativos, y para pagar a accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas.

Es muy claro que el sistema necesita una cirugía radical. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está “basado en desprecio por la gente”. El explicó que tan pronto uno está en busca de lucrarse, uno no puede estar muy interesado en lo que otras personas se merecen, lo que sienten, ya que eso restringiría nuestra habilidad de ganar dinero de ellos.

Nuestro sistema no debe depender en que algunos se lucren de las desdichas de otros seres humanos. Cuando aseguradoras, hospitales o médicos ven a pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables

Lo cierto es que podemos dar cobertura a todos en los EE.UU. si expandimos el plan federal Medicare a todas las personas que residan en el país, sin importar su estado migratorio, o su estado de salud. El Medicare es la aseguradora federal sin fines de lucro que ha cubierto eficientemente, y con cuidado de calidad, a nuestras personas mayores.

Esto se lograría pagado con un impuesto que representaría menos de lo que la mayoría de los empleados o de sus empleadores pagan hoy en seguros. Así, en un solo paso, se daría cobertura a los no asegurados, se bajarían significativamente los costos administrativos y se avanzaría en la prevención.

Es por eso que debemos educarnos y demandar a todos los que desean la presidencia de este país a que expandan el Medicare como el seguro médico nacional, donde todos estemos cubiertos, y cuyo único propósito sea mejorar nuestra salud y no obtener ganancias.

es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en NY.

Wal-Mart’s version of affordable access

Wal-Mart to open 400 in-store clinics

Reuters
April 24, 2007

Wal-Mart Stores Inc. said on Tuesday that it will contract with local hospitals and other organizations to open as many as 400 in-store health clinics in the next two to three years.

Should current market forces continue, the world’s largest retailer said up to 2,000 clinics could be in Wal-Mart stores over the next five to seven years.

It has said the clinics are expected to boost the health of its shoppers and should also help sales by drawing consumers into its stores.

“We think the clinics will be a great opportunity for our business. But most importantly, they are going to provide something our customers and communities desperately need — affordable access at the local level to quality health care,” said Wal-Mart Chief Executive Officer Lee Scott in a statement.

http://investing.reuters.co.uk/news/articleinvesting.aspx?type=tnBusinessNews&storyID=2007-04-24T174019Z_01_WEN6901_RTRIDST_0_BUSINESS-WALMART-CLINICS-DC.XML

Comment:

By Don McCanne, MD

We desperately need to reinforce our rapidly deteriorating primary care infrastructure. It would provide us with greater access to higher quality, comprehensive health care, and would do so at a lower cost.

The Wal-Mart clinics actually will improve accessibility to the limited services that they offer, and do so at affordable rates. But the clinics would further fragment services that should be provided at the primary care medical home. They skim off the easy, low-cost, bread-and-butter medical services that help pay the overhead expenses of primary care practices. They also fragment patients’ medical records, such as creating uncertainty as to their immunization status, uncertainty in monitoring of their chronic diseases such as hypertension and diabetes, and uncertainty as to medication compliance and drug incompatibilities. These clinics threaten to accelerate the further demise of the medical home.

As long as we continue to reject a comprehensive government solution to our health care crisis, the private sector will always be ready with profitable innovations. Does anyone seriously believe that we should continue to observe from the sidelines the Walmartization of health care? Apparently so, judging by the inertia.

Health care: The best won’t be the easiest

Saul Friedman
Newsday
April 21, 2007

As we’ve discussed, “Medicare for All” may seem the simplest and most logical path to universal health care. But the nation’s conservative traditions and the entrenched multizillion-dollar for-profit health care establishment will be formidable obstacles on that path.

It took 20 years of political struggle to get Medicare, and it passed only because an overwhelmingly elected Democratic president, Lyndon Johnson, had veto-proof majorities in both houses of Congress. Such one-party control is not the case now, nor will it be after 2008, unless there is a political earthquake.

Thus, any proposal for universal health care will have to reckon with the combined power of the nation’s richest and most powerful lobbies – the insurance industry and drug manufacturers, as well as medical professionals who make out well in the current system. People are easily fooled by misleading ads. Remember the insurance lobby’s “Harry and Louise”?

My mail shows that while most Americans say they favor publicly supported universal health care and social insurance, including Medicare and Social Security, a vocal minority strongly believes that would lead to socialism or worse. The minority will be aided by a network of right-wing think tanks that never supported Medicare but helped kill the Clinton plan in 1994.

Every Democratic presidential candidate favors one form or another of universal health care. Along with several Republican governors, they have proposed what they believe is a more politically palatable path than Medicare for All – a combination of public and private health insurance. They would mandate that individuals buy insurance and, if necessary, raise revenues to subsidize those purchases.

Most of the more pragmatic proposals reject the single-payer approach, fearing it would run afoul of lobbying campaigns against centralized government control of health care. The latest proposal, called AmeriCare, comes from one of the most liberal members of Congress, Rep. Pete Stark (D-Calif.). Like most others, it would depend on private, for-profit insurance companies to provide health care for the non-elderly.

Even AARP, which earned $379 million in royalties in 2005, mostly from health insurance sales, appears to favor universal public and private health care coverage. AARP endorsed and makes millions from Part D, which is based wholly on private coverage. Last month’s AARP Bulletin reported on various state schemes for universal private coverage, but made only passing mention of the Medicare for All proposals in Congress.

The most comprehensive public-private proposal favored by some liberal groups has come from Yale political scientist Jacob S. Hacker. Writing for the liberal Economic Policy Institute, Hacker said he seeks “to avoid the dismal fate of previous reform campaigns” that ran afoul of budget problems, public resistance to change and “the embedded realities of the present system.”

His proposal, Health Care for America, would “extend insurance to all non-elderly Americans through a new Medicare-like program and workplace health insurance…. Every legal resident of the U.S. who lacks access to Medicare or good workplace coverage would be able to buy into the ‘Health Care for America Plan,’ a new public insurance pool modeled after Medicare….Employers would be asked to either provide coverage as good as this new plan or make a relatively modest payroll-based contribution to Health Care for America.

“It would not eliminate private employment-based insurance….It is not single-payer – a vision that, for both political and budgetary reasons, is unlikely to be achieved in the near future. Nonetheless, Health Care for America does embody many of the key virtues of a universal Medicare-like program.”

Hacker’s plan would put private insurance in competition with a Medicare-type plan to provide coverage that would be guaranteed. “Health Care for America,” he writes, would provide “a generous package of benefits…greater choice.” (See epi.org for the full text of Hacker’s proposal.)

Diane Archer, former president of the New York-based Medicare Rights Center, applauded the proposal as a way to create competition between public and private insurers, and predicted that for-profit insurers would not compete because “they would still try as hard as possible to avoid insuring the people with the costliest conditions.”

President George W. Bush, who opposes government involvement in health care, says universal coverage should be provided only by private insurers. Under his recent proposal, government would grant people more tax incentives – greater deductions – to buy health insurance, perhaps through their employers.

But many of the 45 million workers who are uninsured don’t pay enough taxes to benefit from any deductions. Many cannot afford insurance for themselves and their families, and others can’t qualify because of adverse medical histories.

While the president opposes government health insurance for others, he and his immediate family, including his mother and father, have benefitted most of their lives from government-supplied, taxpayer supported health insurance. And they’ll never be without that coverage. They (as well as Vice President Dick Cheney and members of Congress) earned it with government service. If government coverage is good enough for them, what about the rest of us?

The most cogent criticism of the plans offered by Hacker and several governors came in an editorial by the Des Moines Register. It said that requiring the purchase of health insurance, called “individual mandates,” through employers or subsidies, “is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate.”

Noting that a Register reader who bought an AARP-endorsed plan for $700 a month ended up with $200,000 in bills when he was treated for cancer, the editorial said, “Our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage.”

Copyright 2007 Newsday Inc.

Incremental Health Reform: Whose Life Doesn’t Count?

by Rose Ann DeMoro
The Huffington Post
04.11.2007

Listening to the purveyors of conventional wisdom, you might think only an incremental approach on healthcare reform is possible.

The most comprehensive reform, HR 676 in Congress, (and its state versions, such as SB 840 in California), providing guaranteed healthcare as an expanded and improved Medicare for all, is not politically feasible.

So, the pundits insist, settle for what we can get.

Lower the expectations and turn down the public heat, they advise. Gradualism – extending health coverage to some – is the mantra of the day, fawned over by some politicians and advocacy groups alike. The staged appearance of “bi-partisanship” or “strange bedfellows” for health reform is often the only purpose of grand pronouncements of support for universal health care. Whether the proposals actually solves the health care crisis is irrelevant or secondary to the hype.

Virtually all the gradual reforms being touted would reinforce a dysfunctional system with as many standards of care as there are dollars to purchase them. It would further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.

For the proponents of political expediency, the question remains who will be left behind while we wait?

Every year, 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health coverage.

Among those un-covered, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment. Heart attack victims are less likely to receive angioplasty. People without pneumonia are less likely to receive X-rays or consultations. Those with colorectal cancer are 70% more likely to die within three years.

The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care (drugs and surgical interventions). Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and one third of credit card debt.

The public is fed up, and they’re ahead of the politicians and policy wonks. A New York Times/CBS poll last month found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.

As the polls show, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, provides one of the best arguments against incremental steps. When Medicare was enacted 42 years ago, following a broad grassroots campaign, many believed the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

Similarly, incremental healthcare reforms in Maine, Massachusetts, Minnesota, Washington, Vermont, and Tennessee, that were supposed to lead to universal coverage failed to produce any real reduction in the number of uninsured.

Moreover, by pushing further away the day of real reform, we open the door to some of the worst alternatives, from the Bush administration tax schemes to the current fad of forcing everyone to buy insurance.

Both of these schemes end up saddling people with high deductible insurance plans that more and more people are finding accelerate the healthcare crisis.

In January, a vice president of the Kaiser Family Foundation testified to Congress that one in six privately insured adults have “substantial problems paying their medical bills.” And, a new study this week by Harvard Medical School researchers in the Journal of General Internal Medicine documented that the financial burden of such plans is especially onerous for women who typically need more routine medical visits than men, and thus bear double the out-of-pocket costs.

It’s time to stop promoting inferior approaches and insist on real reform.

American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well.

Un seguro médico, para todos, de por vida

Jaime Torres
El Diario
OPINIóN – 04/24/2007

En toda la nación el tema de la crisis en nuestro sistema de salud está candente y la gente está demando a los políticos que la resuelvan. Hay 47 millones de personas sin cobertura médica — 14 millones son hispanos — y más de 50 millones con seguros inadecuados. El Instituto de Medicina reportó que cada año 18,000 personas mueren por falta de cobertura médica.

En salud, los EE.UU. gastan por persona más que cualquier otro país avanzado (casi el doble de Canadá y Francia). Aun así, tenemos la más alta mortalidad infantil y casi la más baja expectativa de vida del mundo desarrollado. Es muy claro que hay mucho sufrimiento y que las propuestas para “mejorarlo” en recientes años han tenido poco resultado.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para curar una úlcera en un pie; he peleado con aseguradoras por denegar procedimientos necesarios, y he visto niños recibir cuidado deficiente porque tenían Medicaid–un seguro que muchos ven de segunda clase. Es increíble que en el país más rico del mundo haya tanta injusticia y dolor.

Pero los demás países desarrollados brindan atención de salud a todos. La única razón que no tenemos cobertura universal es la espectacular ineficiencia de nuestro sistema. Aunque los EE.UU. gastan $2 trillones en gastos de salud, $600 billones nunca llegan a la gente, pero se usan en gastos administrativos, y para pagar a accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas.

Es muy claro que el sistema necesita una cirugía radical. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está “basado en desprecio por la gente”. El explicó que tan pronto uno está en busca de lucrarse, uno no puede estar muy interesado en lo que otras personas se merecen, lo que sienten, ya que eso restringiría nuestra habilidad de ganar dinero de ellos.

Nuestro sistema no debe depender en que algunos se lucren de las desdichas de otros seres humanos. Cuando aseguradoras, hospitales o médicos ven a pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables

Lo cierto es que podemos dar cobertura a todos en los EE.UU. si expandimos el plan federal Medicare a todas las personas que residan en el país, sin importar su estado migratorio, o su estado de salud. El Medicare es la aseguradora federal sin fines de lucro que ha cubierto eficientemente, y con cuidado de calidad, a nuestras personas mayores.

Esto se lograría pagado con un impuesto que representaría menos de lo que la mayoría de los empleados o de sus empleadores pagan hoy en seguros. Así, en un solo paso, se daría cobertura a los no asegurados, se bajarían significativamente los costos administrativos y se avanzaría en la prevención.

Es por eso que debemos educarnos y demandar a todos los que desean la presidencia de este país a que expandan el Medicare como el seguro médico nacional, donde todos estemos cubiertos, y cuyo único propósito sea mejorar nuestra salud y no obtener ganancias.

es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en NY.

WellPoint advocates shift to underinsurance

Not in poverty but not insured

By Tim Evans
The Indianapolis Star
April 22, 2007

More than one-third of the 46 million uninsured in the United States live in families with incomes of more than $40,000. The nation’s median household income was $46,326 in 2005. These people are among the fastest growing subgroup of uninsured today.

(N)ational surveys show the largest increase has been among families earning $30,000 to $39,999. The number of uninsured in that group rose 31 percent from 2000 to 2005, and the ranks of the uninsured among families earning $40,000 to $49,999 increased 25 percent.

For many trying to enter the individual coverage market, the cost can cause sticker shock, said Jessica Waltman, vice president of policy and state affairs with the National Association of Health Underwriters.

“Many of these people are coming from a situation where they had group coverage and the employer picked up all or at least the lion’s share of the cost,” she said. “Often, they have no idea of what insurance really costs.”

Rates for individual policies can run anywhere from a few hundred dollars to more than $2,000 a month — depending on a person’s age and health history — and consumers are facing ever-increasing deductibles and out-of-pocket spending.

Jude Thompson, president of individual markets for WellPoint, the nation’s largest health insurer, said the traditional one-size-fits-all approach to marketing insurance no longer works.

“That’s one of the big reasons why we’re where we are today with the uninsured,” he said. “Companies need to change the way they are talking about insurance and offer different products with different price points. We need products that resonate with the different age and income groups and hit the mark with people who can and want to purchase insurance.”

http://www.indystar.com/apps/pbcs.dll/article?AID=/20070422/LOCAL/704220439/-1/ZONES04

Comment:

By Don McCanne, MD

The lack of insurance has now become a problem for families with median household incomes. It is the fastest growing sector of the uninsured.

The crescendo call for universal health care coverage is now heard everywhere. And the private insurance industry is not deaf.

Private insurers cover primarily healthy members of our society: the healthy workforce and their healthy families, and healthy individuals who pass medical underwriting standards. Yet the cost of insuring the healthy alone has resulted in premiums that are much less affordable for average-income families. The private insurers are not only threatened by the prospect of covering higher-cost individuals currently excluded from their plans, they can’t even provide affordable comprehensive coverage for the healthy.

To survive, the private insurers must continue to restrict their markets to the healthy, while supporting public policies that shift the real costs of health care to the taxpayers. Also, and this should set off alarms throughout our nation, they must continue to create more products that are affordable for the healthy by dramatically reducing the financial security that health insurance should be providing. Since their administrative costs are fixed or even increasing (selling new administrative products such as disease management, HSA administration, credit card services, etc.), the reduction in premiums must come from a greater reduction in benefits paid out for health care services.

Thus WellPoint is pushing “different products with different price points” and “products that resonate with the different age and income groups and hit the mark with people who can and want to purchase insurance.” Thus WellPoint is supporting explicitly further fragmentation of risk pools, saving the healthiest of the healthy for its own industry.

Ironically, many of these healthy individuals eventually will develop significant medical problems before they are eligible for Medicare at age 65. Unfortunately, those individuals who “hit the mark” with “low price points” will discover the definition of underinsurance: Their insurance will have failed to provide them with adequate financial security in the face of medical need.

The private insurers are selling us ever more administrative services just to provide an increasing amount of underinsurance for the healthy, while supporting public policies that shift the real costs of health care to the taxpayers. That is not where we should be headed in our efforts to improve health care coverage.

Why do we continue to put up with this? Many say that our politicians have been bought off by the insurance industry lobbyists. But it’s not quite that simple. (For the 2006 elections, Sen. Rick Santorum received the largest amount of campaign contributions from the insurance industry, yet lost his re-election bid.) The real inertia comes from financially-secure, higher-income individuals who still do have comprehensive health plans, and who are concerned about potential compromises that they believe might be part and parcel of a national health insurance program.

That’s some inertia. How are we going to budge that?

Paul O'Neill wants an honest discussion on reform

O'Neill advocates health care as a right

By David Wenner
The Patriot-News
April 19, 2007

With all its wealth, it’s time for America to define health care as a right, said Paul O’Neill, a former Bush Cabinet member (and former CEO of Alcoa) who spoke in Harrisburg yesterday.

The former U.S. Treasury secretary also said Americans should give serious thought to a “pool” to cover health care costs.

He didn’t go so far as calling for a national, single-payer health care system, but he said some Americans will never be able to pay for their health care. Americans who are better off should accept an obligation to help pay for those who can’t afford it, he said.

O’Neill cited frustration with the political debate surrounding health care, saying politicians have failed to lead an honest discussion.

“I think we should get our politicians to quit pandering to us and give us the truth,” he said.

http://www.pennlive.com/business/patriotnews/index.ssf?/base/business/117694502191220.xml&coll=1

Comment:

By Don McCanne, MD

It is refreshing to hear such words coming from a prominent Republican member of the business community. He is explicitly calling for providing health care to everyone (as a right), through a common health care fund (pool), paid for equitably (an obligation of the better off), and achieving it through an honest political process (give us the truth).

With this as a common ground, how much more do we need before we agree to move forward with genuine reform? Can Paul O’Neill bring the Republicans and the business community into an honest discussion? And can the Democrats agree that they would have to advocate primarily for the health care of all Americans, rather than continuing to cater predominantly to the private insurance industry without serious regard to the adverse impact on patients?

It is time for the truth and an honest discussion.

Paul O’Neill wants an honest discussion on reform

O’Neill advocates health care as a right

By David Wenner
The Patriot-News
April 19, 2007

With all its wealth, it’s time for America to define health care as a right, said Paul O’Neill, a former Bush Cabinet member (and former CEO of Alcoa) who spoke in Harrisburg yesterday.

The former U.S. Treasury secretary also said Americans should give serious thought to a “pool” to cover health care costs.

He didn’t go so far as calling for a national, single-payer health care system, but he said some Americans will never be able to pay for their health care. Americans who are better off should accept an obligation to help pay for those who can’t afford it, he said.

O’Neill cited frustration with the political debate surrounding health care, saying politicians have failed to lead an honest discussion.

“I think we should get our politicians to quit pandering to us and give us the truth,” he said.

http://www.pennlive.com/business/patriotnews/index.ssf?/base/business/117694502191220.xml&coll=1

Comment:

By Don McCanne, MD

It is refreshing to hear such words coming from a prominent Republican member of the business community. He is explicitly calling for providing health care to everyone (as a right), through a common health care fund (pool), paid for equitably (an obligation of the better off), and achieving it through an honest political process (give us the truth).

With this as a common ground, how much more do we need before we agree to move forward with genuine reform? Can Paul O’Neill bring the Republicans and the business community into an honest discussion? And can the Democrats agree that they would have to advocate primarily for the health care of all Americans, rather than continuing to cater predominantly to the private insurance industry without serious regard to the adverse impact on patients?

It is time for the truth and an honest discussion.

Employers flip labels in vending machines

Survey: Large firms to offer health care

By Ellen Simon
Houston Chronicle
April 19, 2007

Large companies plan to keep offering health care coverage to employees, but cut costs by investing in initiatives to improve employee health, according to a survey of 448 companies released Thursday (by human resources consultant Hewitt Associates LLC).

63 percent of the companies in the survey said they plan to take aggressive, multiyear steps to help employees improve their health by increasing education and rolling out disease management programs.

Companies’ efforts at improving employee health range from simple things, such as flipping the food in company vending machines so the nutritional information faces out, to an increasing number of in-house clinics and pharmacists to help employees with primary care.

Almost 70 percent of the companies surveyed, which have an average of 18,758 employees, plan to offer tools, including health risk questionnaires and nurse hotlines, so employees can better manage their health, according to the survey.

“I’ve been in a dozen client meetings where the employer has said, ‘I’d gladly be the second (to drop health care), but I’m not going to be the first,'” said James M. Winkler, practice leader of Hewitt’s health management consulting practice.

http://www.chron.com/disp/story.mpl/ap/business/4729009.html

Comment:

By Don McCanne, MD

Large employers have had it with rising health care costs, and many are willing to be the second in line to dump their employee health benefit programs.

In the meantime, since they have no control over the fundamental causes of rapidly rising health care costs, they are turning to innovative programs that depend on a healthier employee population to reduce health care spending. Flipping food in employee vending machines to provide purchasers with nutritional information is a good idea. But this and the other initiatives to improve employee health can’t have more than a negligible impact on total health care spending, even though they are commendable measures.

Large employers do want to be relieved of the burden of very high health care costs. Most recognize that it will require a national solution, and that the government will have to play a significant role. The stumbling block is that they have not yet conceded that we must reform financing by adopting a universal program of social insurance, even though a national, government solution, by definition, is, basically, social insurance.

Employers are unable to visualize how the private insurers could provide affordable, comprehensive coverage for everyone, and, frankly, neither can we. We need to eliminate the private insurers and replace them with a single, universal, national health insurance program.

Until we are ready to accept the inevitable, we can keep flipping the food labels in the vending machines. If we are lucky, that might eliminate one heart attack per generation.

Canada controls costs without compromising health outcomes

A systematic review of studies comparing health outcomes in Canada and the United States

By Gordon H. Guyatt, P.J. Devereaux, Joel Lexchin, Samuel B. Stone, Armine Yalnizyan, David Himmelstein, Steffie Woolhandler, Qi Zhou, Laurie J. Goldsmith, Deborah J. Cook, Ted Haines, Christina Lacchetti, John N. Lavis, Terrence Sullivan, Ed Mills, Shelley Kraus, Neera Bhatnagar
Open Medicine | A peer-reviewed, independent, open-access journal.
Vol 1, No 1 (2007)

Canada and the United States are similar in many ways, and until 40 years ago their healthcare systems were nearly identical. At that time Canada adopted its national health insurance program.

Although both nations continue to rely largely on private funding for drugs, they now differ substantially in both the financing and delivery of physician and hospital services. With respect to financing, Canada has virtually first-dollar, universal public coverage of hospital and physician services. With respect to delivery, not-for-profit institutions provide almost all hospital services, and large for-profit organizations are almost entirely excluded from the provision of physician services. In contrast, the United States relies on a mixture of public and private insurance to finance health care, and leaves 16% of the population without coverage. Investor-owned for-profit providers play a substantial role.

Despite the limitations of the available studies, some robust conclusions are possible from our systematic review. These results are incompatible with the hypothesis that American patients receive consistently better care than Canadians.

Canadian health care has many well-publicized limitations. Nevertheless, it produces health benefits similar, or perhaps superior, to those of the US health system, but at a much lower cost. Canada’s single-payer system for physician and hospital care yields large administrative efficiencies in comparison with the American multi-payer model.

Policy debates and decisions regarding the direction of health care in both Canada and the United States should consider the results of our systematic review: Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost.

http://www.openmedicine.ca/article/view/8/1

Comment:

By Don McCanne, MD

The important policy lesson: Canada’s government-funded and government-administered single payer system dramatically reduced their rate of health care cost increases without having a negative impact on health outcomes. The cost savings alone is a compelling reason to adopt a national health insurance program in the United States.

Since this was a comprehensive review of studies of patients who had accessed the health care delivery system and were under treatment for specific disorders, it automatically excluded many individuals in the United States who were unable to access the system due to financial barriers (e.g., lack of insurance). We can only speculate as to whether including them would have had a negative impact on the measured outcomes for the Unites States. Canada’s system provides access to everyone since financial barriers are eliminated. The ability to provide affordable access to everyone is a second compelling reason for the United States to adopt a national health insurance program.

Incidentally, today’s article is from the inaugural issue of Open Medicine, a new on-line, independent, open-access Canadian medical journal. It represents a “milestone in independence and academic freedom of medical research publishing.” It should be a very valuable resource for us all.