PNHP

The Corporate Crime of Selling Private Health Insurance

The Corporate Crime of Selling Private Health Insurance

by The Corporate Crime Reporter

In most of the world, it is a corporate crime to sell private health insurance.That’s because most countries insure their citizens as a matter of right.

Private insurers dilute the public pool.

One nation, one payer.

Medicare for all.

Everybody in, nobody out.

No bills from the doctor.

No bills from the hospital.

No deductibles.

No co-pays.

No in network.

No out of network.

No corporate profits.

No threat of bankruptcy from health bills.

Health insurance will be the number one domestic political issue in the USA in 2008.

Polls indicate that the majority of the American people want single payer.

But who will deliver?

On Saturday, the Center for American Progress Action Fund and Service Employees International Union (SEIU) sponsored a forum in Las Vegas for presidential candidates to discuss health care.

No Republicans accepted.

Seven Democrats accepted.

All the candidates at the forum agreed that universal health care was the goal. (Even the Business Roundtable and the insurance industry now say they want “universal health care.”)

But only one – Congressman Dennis Kucinich (D-Ohio) – accepts the only answer that will work – single payer.

Medicare for all.

The rest – including Barack Obama, Hillary Clinton, Chris Dodd, Bill Richardson, Mike Gravel, and John Edwards – want some mixture of public and private health insurance.

They know this public/private mix won’t work – the healthy wealthy will buy private insurance, the sick poor will sign on with the government – and the government program will be crippled.

But they don’t have the guts to stand up to the private insurance industry and say – get out.

Kucinich has introduced single payer legislation (HR 676) in Congress that would make it unlawful to sell private health insurance for benefits that are medically necessary.

Last week, we entered the belly of the beast – the American Health Insurance Plans (AHIP) 2007 National Policy Forum at the Capital Hilton in Washington, D.C.

AHIP is the trade association for the companies that will be sacked if single payer becomes law.

We walked into a session titled – Coverage for All Americans: Putting Access at the Top of the National Agenda.

The session was moderated by AHIP President Karen Ignagni.

Not once during the 90-minute session was single payer mentioned.

Universal coverage, yes.

Single payer, no.

But during the discussion, the geography of nowhere was laid out.

On one side, Ron Pollack, executive director of Families USA had teamed up with AHIP’s Ignagni.

On the other, Bill Novelli, CEO of AARP and John Catsellani, president of the Business Roundtable.

AARP and the Business Roundtable have joined with SEIU to form something called Divided We Fail.

Divided We Fail is a corporate liberal answer to single payer.

All Americans should have access to affordable quality health care.

All Americans should have peace of mind about their future long-term financial security.

Families USA and AHIP do a separate dance but mouth similar platitudes.

But both Divided We Fail and Families USA/AHIP dismiss single payer as unworkable.

On the single payer side is Kucinich, about 60 members of the House of Representatives, the California Nurses Association, Physicians for a National Health Program, and Health Care Now.

Kucinich is now the single payer champion.

The problem with Kucinich, of course, is that if he doesn’t get the nomination, he will take the stage at the Democratic Convention in 2008 in Denver – as he did in 2004 in Boston – raise the hand of the corporate nominee and endorse the corporate platform.

Then where will we be?

Nowhere.

Again.

To visit the Crime Reporter’s home page, click here.

Association-sponsored coverage plummets

Health insurance options dwindle for self-employed

Group plans are being dropped or becoming unaffordable to many.

By Lisa Girion
Los Angeles Times
March 27, 2007

A major source of health insurance for people who work for themselves is disappearing, casting thousands of contractors, freelancers and solo practitioners into the ranks of the uninsured with little hope of obtaining new coverage.

Health plans offered by professional associations were once havens for millions of people who couldn’t get coverage anywhere else. But as medical costs have soared, groups representing professions as varied as law and golf have been forced to stop offering the benefit or been dropped by insurers.

More than 8,000 people with coverage through the California Assn. of Realtors could be next if Blue Shield of California succeeds with its plan to cancel the group’s health coverage.

“It’s a real stab in the heart,” said Marcy Garber, 62, an Encino real estate agent whose history of breast cancer makes her an almost-certain reject if she seeks similar coverage on her own.

Although no one tracks association coverage to know how many plans have disappeared, the experience of Marsh Affinity Services is telling. A decade ago, Marsh, which brokers and administers the health plans, had 142 such clients. Today, all but three have shut down.

In its heyday, association health coverage was so popular that brokers touted it as a membership recruiting tool for professional organizations. The demise of the coverage is particularly problematic in states like California, experts say, where a raft of jobs — including many in the service and entertainment sectors — don’t come with health benefits.

“The problem with associations is they go into a death spiral because they get the worst risk,” said Alan Fox, vice president of plan design for the American Psychological Assn. Insurance Trust, which covered thousands of psychologists and their families for 35 years before discontinuing its health plan in 1999.

As havens for people with medical conditions, association health plans are especially vulnerable to rising medical costs, said Janet Trautwein, chief executive of the National Assn. of Health Underwriters.

“Costs are going up everywhere in every type of plan,” Trautwein said. Associations “not only have the normal costs going up, but they have this adverse selection at the same time. It’s a double whammy.”

http://www.latimes.com/business/la-fi-insure27mar27,0,2749192,full.story

Comment:

By Don McCanne, MD

How many more examples do we need? Segregated health insurance risk pools are not effective for financing care of those individuals who have significant health care needs. We desperately need to establish one single risk pool, include everyone, and fund it equitably.

Republicans are well represented in these professional associations, but simply being a Republican will not provide financial security if you have breast cancer and have run out of insurance options. Reform is no longer a partisan issue. Moderates, conservatives and liberals should all have the health care they need, when they need it, without being exposed to the additional burden of financial hardship. We can do this together.

Health coverage for more people just helps insurers

By Milton Fisk
The Journal Gazette
03/26/2007

Suddenly, the most unlikely bunch has turned altruistic. Conservative businesses and politicians want health coverage for the uninsured. Schemes are multiplying about how to do it. Why the change of heart? Beware of those bearing gifts — this altruism is but poorly disguised self-interest.

Look at some apostles of this new altruism. Wal-Mart is an easy case; it hopes to use it to avoid paying any more for health benefits. Why Gov. Arnold Schwarzenegger? He hopes to garner more dollars for powerful private insurers he needs.

What are these schemes?

Common to all of them is the use of public subsidies so the uninsured can buy private insurance. However, spreading private insurance worsens the problems it creates.

The idea came from President Bush’s 2003 Medicare Plan D drug program, by which private insurers get public subsidies. It’s unadulterated corporate welfare. The drug companies get $40 billion a year more because Medicare can’t bargain over what it charges. The insurers’ ads and profits cost the government $5 billion a year.

With Medicare Plan D as inspiration, don’t expect much from our new altruists. Covering more people is an admirable goal. Getting it through private insurance will push inflation in health care through the roof. To modulate this inflation, we’d need public insurance — Medicare (A and B) is an example — extended to all.

In 2005, CEOs at five big insurers received together a total of $14 million plus stock options and grants for over 2 million shares. The aggregate profits in 2006 of these insurers were $12 billion. Still, their premiums have nearly doubled in the past decade. A public insurer seeks no profits, and its chieftains don’t become plutocrats.

Don’t stop here — there’s more to being an expensive parasite. Premiums for private insurance go to marketing as well as health care: the TV ads, junk mail, public relations accounts to burnish a bad image and hucksters signing on employers and hospitals. There’s little of this waste with public insurance.

Then there’s the cost of underwriting — trying to find whose poor health warrants a bigger premium, whose pre-existing conditions will deny them coverage and who to dump from the rolls. This cherry-picking is absent with public insurance; there’s no extra charge or denial for bad luck or poor genes.

Schwarzenegger wants insurers in his state to devote at least 85 percent of premiums to health care. WellPoint says it devotes only 81 percent; as a California giant, its screams will get Arnold back on track. This bickering is juvenile when Medicare has overhead of 3 percent.

Hang on for more — add to private insurers’ overhead a ripple effect on providers. Doctors and hospitals must send bills to multiple insurers. With a single public payer, this inefficiency disappears. Hospitals won’t have to bill insurers; they will operate under annual budgets negotiated with that single payer.

Shouldn’t the competition between multiple insurers save money?

Free enterprise versus big government? That’s not the fight. It’s rather: Pay more or pay less?

When a new altruist says he or she wants more people covered, ask, “Do you want to expand business for private insurers or do you want to reduce inflation in health care costs by having a single public insurer?”

Milton Fisk, a Bloomington resident, is a member of Hoosiers for a Commonsense Health Plan. He wrote this for Indiana newspapers.

The Sacramento Bee on pooling risk

Editorial: Coverage for all

The Sacramento Bee
March 25, 2007

The state regulator of HMOs has fined one of the largest, Blue Cross, $1 million for canceling health policies of enrollees who, among other things, got pregnant. Cancellations like these weren’t isolated, according to the California Department of Managed Health Care. Rather, they were systematic, right down to a computer program that scours the system for enrollees seeking certain kinds of care.

Blue Cross denies wrongdoing. That’s fine. There is a larger lesson here: This health insurance market, the one for individuals or families who don’t automatically get covered through their jobs, is sick. Insurers try to avoid covering people who need care. And many Californians avoid getting insurance until it is in their financial interest to do so. It’s a game, and the game must end somehow. That can only happen by blowing up the individual health insurance market that exists today and replacing it with something that makes more sense. And that can only happen with the California Legislature and Gov. Arnold Schwarzenegger.

There are two basic choices here when it comes to health insurance. One is to get rid of private health insurance altogether and replace it with a program in which the government directly pays doctors and hospitals to provide care. That’s known as single-payer. It is championed by some Democrats, but opposed by the governor. Single-
payer isn’t a likely short-term compromise, but the more we look at this mess, single-payer seems to be an increasingly likely long-term solution because of the many ills of the private insurance market.

The second choice is to fix the insurance market. How? Bottom line: It means that health insurers such as Blue Cross have to cover all who apply, even those who are eight months pregnant. On the flipside, everyone — or just about everyone — has to have insurance. It can be through his or her company. It can be through a government-
sponsored program. What is important is to throw everyone into the pool. Insurance, when it works, is all about spreading risks.

Either the governor and the Legislature somehow create this pool, or they don’t. All of the solutions by necessity would impose various mandates — either on employers, on individual Californians or in some combination. And any solution will require money. Why? If the state were to require everyone to have coverage and require insurance companies to cover anyone who signs up, that would include many low-
income Californians who don’t have insurance today. Those Californians can’t be expected to pay full freight. And they can’t be left out of the equation, only to wander later into emergency rooms and expect care.

In any sane health care system, getting pregnant should never be a cause to lose health care.

http://www.sacbee.com/110/story/143154.html

Comment:

By Don McCanne, MD

The Bee’s editorial board understands: “What is important is to throw everyone into the pool.”

Segregated pools of healthy individuals won’t do it. Yet that is the specialty of the private insurance industry – pooling risks of the healthy workforce and their healthy families.

If we are to effectively spread the risk, we would have to transfer funds from the segregated pools insuring the healthy, to pools that include those with high-cost needs. But that creates an actuarial nightmare that invites the inequities of gaming the system. It would be much easier and much more efficient to establish one single universal risk pool. It would also finally make the financing of health care equitable since contributions would be based on ability to pay.

Once we remove the requirement for the private plans to pool risk, what is left for them to do for us? Think hard. We’re sure paying them a lot for whatever it is they do.

Maybe it is time for us to tell those in the health insurance industry to go get a real job.

Gray Matters

Staying with Medicare will help keep it alive

By Saul Friedman
Family & Relationships
Newsday
March 24, 2007

Regular reader Martin Selig of Carle Place reminded me of a warning I had intended to convey about the problems with so-called Medicare Advantage plans.

The deadline for enrollment is March 31. He wondered whether an advertisement for one such plan – Liberty Advantage – isn’t intended to “lure people away from government controlled Medicare and put them in the hands of private HMOs.” The short answer, of course, is yes.

Beginning in 1997, the Congress pressured President Bill Clinton to further open Medicare to private plans, Medicare HMOs. Despite government subsidies, the HMOs abandoned the Medicare business and subscribers when they failed to make the profits they expected. But it was the opening wedge to Medicare privatization.

Then, under the Bush administrations, the HMOs got renewed life as “Medicare Plus” plans. With the passage of the privatized Part D drug plan, Republicans gave the insurance companies a huge “stabilization fund” to cushion them against possible losses and renamed the plans “Medicare Advantage.” And with the administration starving traditional Medicare, the Medicare Advantage plans are gaining subscribers because they seem to cost no more than Medicare but provide more coverage.

The Kaiser Family Foundation says there are 8.3 million subscribers to Medicare Advantage plans, up from 5.5 million since 2004. That’s because, in addition to the stabilization fund, they are further subsidized by the government, paid on average 12 percent more than the cost of traditional fee-for-service Medicare for each subscriber.

Thus, the first problem: Each new subscriber to a Medicare Advantage plan means another of the thousands of cuts that are bleeding Medicare to death, which explains why Medicare advocates in the Congress want to reduce the subsidy. You’d help by staying with Medicare.

Also, in addition to the advertising campaigns, the Medicare Rights Center and newspapers report that brokers and agents, some of them claiming to be from Medicare, are convincing beneficiaries to switch from traditional Medicare and sign up for Medicare Advantage plans. They claim, falsely, that beneficiaries may use doctors of their choice. Or they claim what they’re selling is “just like Original Medicare,” said the Medicare Rights Center.

It isn’t, of course, but the salespeople, who are paid commissions, pick on the more vulnerable elderly who live alone. No one from Medicare is authorized to call or visit you to sell you anything. People are being switched without fully understanding what is happening, and when you sign up for a Medicare Advantage plan, despite what you may be told, you must use doctors, labs and hospitals in the plan’s network. You’re no longer in traditional Medicare. And you may not be covered when you visit out of town. Also you’re locked into a Medicare Advantage plan for at least a year.

Third, although you may be told that you need pay only your monthly Part B premium ($93.50 for most people), the drug premiums and drug costs and co- pays for doctor and lab visits can add up.

And the Medicare Advantage premiums (in addition to the Part B premiums) vary wildly depending on where you live. Government subsidies differ from county to county.

For example, in New York, HIP and Empire Blue Cross offer Medicare Advantage plans in Nassau County for no premiums (in addition to the Part B premium) for the health or drug coverage, and they pay for generic drugs in the doughnut hole coverage gap. For comparable coverage in adjoining Suffolk County, HIP charges a $99 monthly premium (in addition to Part B) for the health care, $33.90 monthly for the drugs, with generic coverage in the hole; Empire charges a $116 monthly health premium plus $21.90 a month for drug coverage.

The Medicare Advantage HMOs remain notoriously slow in paying claims, refusing at first an average of 40 percent, according to New York Times columnist Paul Krugman, who reports that angry doctors and hospitals are hiring companies to challenge the insurers. Some insurers are “cherry pickers” seeking to cover the youngest and healthiest clients; others are “lemon droppers,” companies that refuse or drop coverage for the chronically ill.

Depending on your situation (if you travel or need certain doctors and hospitals), a better course is to have a trio of plans good anywhere in the U.S.: Traditional Medicare; a supplemental policy, such as Medigap, and a relatively inexpensive Part D drugs-only plan.

For help in deciding, call the health insurance counseling hotline, 800-701- 0501; Medicare Rights Center, medicare rights.org at 800-333-4114.

Here’s another piece of evidence that this administration is out to kill Medicare. Because the Congress imposed an arbitrary cap on Medicare – premiums must always pay for 15 percent of Medicare’s budget – the Part B premiums are expected to rise by a record 17 percent next year, from $93.50 to $109.40, according to the nonpartisan TREA Senior Citizens League.

For most beneficiaries, that means Medicare premiums next year will have increased 77 percent in six years, wiping out the Social Security cost-of- living increases of 15 percent for the same period. The league estimated that 22 million Social Security recipients will see no cost-of-living increase because of the greater deductions from their checks for Medicare.

More affluent beneficiaries will be socked with premiums approaching $200 a month. That’s certain to drive many people away from Medicare and leave it as a program for the low-income elderly. I believe that has been the administration’s plan.

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250,

or by e-mail at saulfriedman@comcast.net. Copyright 2007 Newsday Inc.

Candidates Outline Ideas for Universal Health Care

By ROBERT PEAR
The New York Times
March 25, 2007

LAS VEGAS, March 24 — Seven Democratic candidates for president promised Saturday to guarantee health insurance for all, but they disagreed over how to pay for it and how fast it could be achieved.

Senator Hillary Rodham Clinton of New York assailed the health insurance industry and said she would prohibit insurers from denying coverage or charging much higher premiums to people with medical problems.

John Edwards, the former senator from North Carolina, offered the most detailed plan for universal coverage, saying he would raise taxes to help pay the cost, which he estimated at $90 billion to $120 billion a year.

Senator Barack Obama of Illinois appeared less conversant with the details of health policy and sometimes found himself on the defensive, trying to explain why he had yet to offer a detailed plan to cover all Americans.

“The most important challenge is to build a political consensus around the need to solve this problem,” Mr. Obama said.

Gov. Bill Richardson of New Mexico offered a potpourri of ideas to achieve universal coverage, including tax credits to help people buy insurance and an option to let people ages 55 to 64 buy coverage through Medicare.

To help pay for his proposals, Mr. Richardson said, he would “get out of Iraq” and redirect money from the military to health care.

The candidates spoke at a forum on health care at the University of Nevada, Las Vegas, sponsored by the Service Employees International Union and the Center for American Progress Action Fund, a liberal advocacy group. Sponsors of the forum said they had also invited Republican candidates, but none attended.

Health care is emerging as a top issue in the 2008 presidential race, as businesses join consumers in demanding action to curb costs and cover the uninsured.

Nevada has gained new prominence in the political calendar. It will provide an early test of voter sentiment in a Sunbelt state with a large Hispanic population, and the results here could help create momentum for a Democratic candidate going into New Hampshire. Nevada Democrats are scheduled to hold presidential caucuses on Jan. 19 next year, five days after the Iowa caucuses and three days before the first-in-the-nation primary in New Hampshire.

Mrs. Clinton said she hoped to make health care “the No. 1 voting issue in the 2008 election.”

Her remarks were reminiscent of a speech she gave to the service employees union in May 1993, when she attacked “price gouging, cost shifting and unconscionable profiteering” in health care and the insurance industry.

On Saturday, she said that the failure of her proposal for universal coverage in 1994 made her more determined to achieve the goal now.

“It also makes me understand what we are up against,” Mrs. Clinton said. “We have to modernize and reform the way we deliver health care. But we have to change the way we finance it. That’s going to mean taking money away from people who make out really well right now.”

Mrs. Clinton complained that “insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you’re insured, they try to avoid paying for the health care you receive.”

To deal with such problems, Mrs. Clinton said, “we could require that every insurance company had to insure everybody, with no exclusion for pre-existing conditions.”

Mr. Edwards, who disclosed on Thursday that his wife’s cancer had returned in an incurable form, reaffirmed that he was “definitely in the race for the duration.”

He said that he and his wife, Elizabeth, were getting “too much credit” for their courage and determination. Millions of women have had to struggle with cancer “without what we have, without great health care coverage, without knowing they can get all the medications they need,” he said.

“One of the reasons that I want to be president of the United States,” Mr. Edwards said, “is to make sure that every woman and every person in America gets the same kind of things we have.”

Under the Edwards plan, employers would have to cover their employees or pay into a fund that would finance coverage. Senators Clinton and Obama also expressed interest in this idea.

Mr. Edwards said he would help pay for his plan by “rolling back George Bush’s tax cuts for people making more than $200,000 a year.”

Mr. Richardson said universal coverage “could be achieved in my first year as president,” if voters sent more Democrats to Congress.

As president, he said, he would duplicate the steps he has taken as governor, to “cut junk food out of schools” and to ban smoking in most workplaces, including bars, restaurants and stores.

Mr. Obama said that he would be issuing a detailed plan “over the next couple of months” to achieve universal coverage by the end of the first term of the next president, in January 2013.

When asked why he did not have such a plan, he said, “Our campaign now is a little over eight weeks old.”

While most people get coverage through employers, Mr. Obama said, he wants to foster federal and state purchasing pools. Employers would still have the option of providing coverage, he said, but after 10 or 20 years, “many people may find that they get better coverage,” or better value, outside their employers.

Mr. Obama said he did not know how much it would cost to achieve universal coverage. In response to a question, he said, “I have not foreclosed the possibility that we might need additional revenue” to reach that goal.

“We should not underestimate the amount of money that could be saved in the existing system,” Mr. Obama said. But he opposed cuts in payments to hospitals, doctors and nurses.

Another candidate, Senator Christopher J. Dodd of Connecticut, emphasized his experience, saying that as president he could immediately begin work with Senate committee chairmen to forge a consensus on legislation to cover all Americans.

Mr. Dodd said he would push for legislation making it easier for nurses to form unions, even if they performed some supervisory duties.

Among the candidates at the forum, Representative Dennis J. Kucinich of Ohio offered the most sweeping proposal, to create “a universal, single-payer not-for-profit health care system providing Medicare for all.”

“Health care is a right, not a privilege,” Mr. Kucinich said.

Another candidate, former Senator Mike Gravel of Alaska, called for “a universal single-payer plan.” He said he would give people vouchers, which could be used to pay doctors and hospitals, and a choice of five or six health plans.

(Note by PNHP – Gravel’s plan is not a single payer plan. It is a variant of “managed competition” as proposed by right-wing Stanford economist Victor Fuchs)

Blog postings from the Campaign for America's Future

SEIU Candidate Debate, Las Vegas, 3/24/07

Universal Care: Getting The Right Mix

Submitted by Roger Hickey on Mon, 2007-03-26 15:22.

At Saturday’s health care forum for presidential candidates, John Edwards was bold, detailed and specific–but didn’t diagnose the problem.

Barack Obama was vague–but stressed that no president can do it without the people.

Dennis Kucinich diagnosed the problem, and pushed immediate transformation.

Hillary Clinton, surprisingly, forcefully adopted Kucinich’s diagnosis (before he spoke).

Put them all together–in the right way–and you have a winning health care plan.

I was at the forum in Las Vegas where the Center for American Progress and SEIU made a real contribution to the political debate by getting seven Democratic candidates together to discuss health care.

In a political system where presidential candidates, not party committees, formulate policy for the parties, forcing the candidates to refine their views early–before a crowd of party and union activists–is not a bad thing. Irresponsibly, CSPAN didn’t cover it live, but CAP streamed the event live on the web, and will soon have a transcript available.

Everyone expected former senator Edwards to stress the specifics of his plan for health care for all, and he did. The audience was not so prepared for Obama’s vagueness, but the Illinois senator stuck to principles on the grounds that he was still working on his plan.

But the real surprise was Clinton’s forceful diagnosis of the health care problem–and of her failure to win coverage for all in her husband’s administration.

The New York senator pointed to the power and greed of the insurance industry. She told the Nevada crowd that the failure of her proposal for universal coverage in 1994 made her more determined to achieve the goal now.

As reported by Robert Pear in Sunday’s New York Times, Clinton declared, “[My experience] also makes me understand what we are up against. We have to modernize and reform the way we deliver health care. But we have to change the way we finance it. That’s going to mean taking money away from people who make out really well right now.”

Pressed to explain what she meant by moderator Karen Tumulty of Time, she complained that:

…Insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you’re insured, they try to avoid paying for the health care you receive.

(Monday’s front-page story in The New York Times offers a particularly vivid example of that in the long-term care industry.)

With that, Clinton established a strong starting point for an explanation that most Americans can understand about why health care is in crisis. She also announced she would soon introduce legislation to “require that every insurance company had to insure everybody, with no exclusion for pre-existing conditions.”

And with that, Hillary left open the question each of the major candidates need to answer: If the insurance industry is the problem, do we want them to be the centerpiece of an expanded system of subsidies and regulations to try to “incentivize” or force them to cover everyone? And if we go down that road, will we ever get health care costs under control?

Even Edwards, with his admirably frank and detailed plan, does not really answer that question. He builds his coverage-for-all plan around both private insurers and a public, Medicare-like system, claiming that the public’s choices could eventually lead to the private companies losing the competition.

Kucinich was very clear in his response: Even if you set up a public program to compete with private insurers–and even if you regulate the private insurers (as Clinton and Schwarzenegger want to do)–the private insurance companies will find ways to “cherry pick” and cover only the youngest, healthiest and richest parts of the population. And, the representative from Ohio warned, you will end up with only the oldest, sickest and poorest people in the public system–and that is not level competition.

Kucinich’s other warning: Private insurance, with its advertising and administrative costs (necessary to do their “cherry picking” and claims-denying) can never be the basis for an efficient health care system that can get overall costs stabilized.

Kucinich’s problem is the public’s resistance to rapidly imposing his “single-payer” system on everyone–even those (represented memorably by Harry and Louise) who are happy with their current health plan and don’t want to change.

But Clinton’s diagnosis of the health care problem could lead her (or Obama or Edwards) to embracing a gradual shift to a Medicare-style public plan for everyone (individuals and corporations) for whom private insurance is not working.

There was a lot of agreement on important fundamentals at the debate: Edwards, Clinton and Obama all agreed that requiring employers to either insure their workers or pay into a fund to cover them (“pay or play”) is probably the way to go.

So if you put them all together in the right way, you just might come up with a winning health care plan, a winner for the candidate and for the American people.

P.S. — I’m glad I went out to Las Vegas rather than trying to get the streaming video to work. Being there made me realize how for the Democratic Party this health care vision is very much a work in progress. People need to understand that we have the power–though our tough questions, through the lines we chose to applaud and through our own strong advocacy of what kind of health program the candidates should adopt. We have the power to shape the program and the message, and the winning strategy.

P.P.S — I told the taxi driver who took me to the Cox Center at the University of Nevada at Las Vegas about the debate about to take place inside. He hadn’t heard about it but thought a health care solution was really needed. Hospitalized with a serious illness–and no health insurance–he ended up with $250,000 in medical debts and had to declare bankruptcy.

After he got well, he tried to get a job (one with health insurance) at one of the big unionized hotels on the Vegas strip, but the hotel turned him down for the job because his credit records indicated he had declared bankruptcy!

This kind of Catch-22 health care system is undermining everyone’s economic security and Americans are looking to us for an alternative.

The Health Care Questions I Still Have

Submitted by Bill Scher on Mon, 2007-03-26 18:05.

After watching Saturday’s presidential candidate forum on health care, and judging the candidates using Roger Hickey’s five health care questions, I’m left with key questions for each Oval Office aspirant.

To former Sen. John Edwards: your plan sets up competition between private insurers and a new “Medicare-style” government plans for everyone under 65. You argue that with competition, we will see if Americans want public or private plans. But what will you do to ensure the plans compete on a level playing field?

To Sen. Hillary Clinton: You accurately identified the problem with private insurers, how they make a profit by either trying to “avoid insuring you” or “try[ing] to avoid paying for the health care you receive.” But the 1993 health care plan you supported solely relied on private insurers to deliver health care coverage. Will you commit to offering some sort of public plan so we can reduce our reliance on private insurers?

To Sen. Barack Obama: The principles you laid out appear to track the plan that John Edwards has offered. In fact, you called Edwards’ plan “very credible.” What can you propose that would improve upon the Edwards plan?

To Gov. Bill Richardson and Sen. Chris Dodd: Are you actually pledging to achieve universal coverage, or are you only offering universal “access” to coverage, which will allow some to fall through the cracks?

To Rep. Dennis Kucinich: You make a compelling case for an immediate move to a single-payer system, but how do you convince those Americans who are content with their coverage that such a system won’t take away what they have?

To Sen. Joe Biden: The Nevada Caucus 2008 blog checks your past statements and concludes you chose not the attend the forum because you’re not really for universal coverage. Is that true?

To the Republican candidates, who all skipped the forum: Do you really think you can win the White House if you won’t take public questions on what you’re going to do about our health care crisis?

Blog postings from the Campaign for America’s Future

SEIU Candidate Debate, Las Vegas, 3/24/07

Universal Care: Getting The Right Mix

Submitted by Roger Hickey on Mon, 2007-03-26 15:22.

At Saturday’s health care forum for presidential candidates, John Edwards was bold, detailed and specific–but didn’t diagnose the problem.

Barack Obama was vague–but stressed that no president can do it without the people.

Dennis Kucinich diagnosed the problem, and pushed immediate transformation.

Hillary Clinton, surprisingly, forcefully adopted Kucinich’s diagnosis (before he spoke).

Put them all together–in the right way–and you have a winning health care plan.

I was at the forum in Las Vegas where the Center for American Progress and SEIU made a real contribution to the political debate by getting seven Democratic candidates together to discuss health care.

In a political system where presidential candidates, not party committees, formulate policy for the parties, forcing the candidates to refine their views early–before a crowd of party and union activists–is not a bad thing. Irresponsibly, CSPAN didn’t cover it live, but CAP streamed the event live on the web, and will soon have a transcript available.

Everyone expected former senator Edwards to stress the specifics of his plan for health care for all, and he did. The audience was not so prepared for Obama’s vagueness, but the Illinois senator stuck to principles on the grounds that he was still working on his plan.

But the real surprise was Clinton’s forceful diagnosis of the health care problem–and of her failure to win coverage for all in her husband’s administration.

The New York senator pointed to the power and greed of the insurance industry. She told the Nevada crowd that the failure of her proposal for universal coverage in 1994 made her more determined to achieve the goal now.

As reported by Robert Pear in Sunday’s New York Times, Clinton declared, “[My experience] also makes me understand what we are up against. We have to modernize and reform the way we deliver health care. But we have to change the way we finance it. That’s going to mean taking money away from people who make out really well right now.”

Pressed to explain what she meant by moderator Karen Tumulty of Time, she complained that:

…Insurance companies make money by spending a lot of money, and employing a lot of people, to avoid insuring you, and then if you’re insured, they try to avoid paying for the health care you receive.

(Monday’s front-page story in The New York Times offers a particularly vivid example of that in the long-term care industry.)

With that, Clinton established a strong starting point for an explanation that most Americans can understand about why health care is in crisis. She also announced she would soon introduce legislation to “require that every insurance company had to insure everybody, with no exclusion for pre-existing conditions.”

And with that, Hillary left open the question each of the major candidates need to answer: If the insurance industry is the problem, do we want them to be the centerpiece of an expanded system of subsidies and regulations to try to “incentivize” or force them to cover everyone? And if we go down that road, will we ever get health care costs under control?

Even Edwards, with his admirably frank and detailed plan, does not really answer that question. He builds his coverage-for-all plan around both private insurers and a public, Medicare-like system, claiming that the public’s choices could eventually lead to the private companies losing the competition.

Kucinich was very clear in his response: Even if you set up a public program to compete with private insurers–and even if you regulate the private insurers (as Clinton and Schwarzenegger want to do)–the private insurance companies will find ways to “cherry pick” and cover only the youngest, healthiest and richest parts of the population. And, the representative from Ohio warned, you will end up with only the oldest, sickest and poorest people in the public system–and that is not level competition.

Kucinich’s other warning: Private insurance, with its advertising and administrative costs (necessary to do their “cherry picking” and claims-denying) can never be the basis for an efficient health care system that can get overall costs stabilized.

Kucinich’s problem is the public’s resistance to rapidly imposing his “single-payer” system on everyone–even those (represented memorably by Harry and Louise) who are happy with their current health plan and don’t want to change.

But Clinton’s diagnosis of the health care problem could lead her (or Obama or Edwards) to embracing a gradual shift to a Medicare-style public plan for everyone (individuals and corporations) for whom private insurance is not working.

There was a lot of agreement on important fundamentals at the debate: Edwards, Clinton and Obama all agreed that requiring employers to either insure their workers or pay into a fund to cover them (“pay or play”) is probably the way to go.

So if you put them all together in the right way, you just might come up with a winning health care plan, a winner for the candidate and for the American people.

P.S. — I’m glad I went out to Las Vegas rather than trying to get the streaming video to work. Being there made me realize how for the Democratic Party this health care vision is very much a work in progress. People need to understand that we have the power–though our tough questions, through the lines we chose to applaud and through our own strong advocacy of what kind of health program the candidates should adopt. We have the power to shape the program and the message, and the winning strategy.

P.P.S — I told the taxi driver who took me to the Cox Center at the University of Nevada at Las Vegas about the debate about to take place inside. He hadn’t heard about it but thought a health care solution was really needed. Hospitalized with a serious illness–and no health insurance–he ended up with $250,000 in medical debts and had to declare bankruptcy.

After he got well, he tried to get a job (one with health insurance) at one of the big unionized hotels on the Vegas strip, but the hotel turned him down for the job because his credit records indicated he had declared bankruptcy!

This kind of Catch-22 health care system is undermining everyone’s economic security and Americans are looking to us for an alternative.

The Health Care Questions I Still Have

Submitted by Bill Scher on Mon, 2007-03-26 18:05.

After watching Saturday’s presidential candidate forum on health care, and judging the candidates using Roger Hickey’s five health care questions, I’m left with key questions for each Oval Office aspirant.

To former Sen. John Edwards: your plan sets up competition between private insurers and a new “Medicare-style” government plans for everyone under 65. You argue that with competition, we will see if Americans want public or private plans. But what will you do to ensure the plans compete on a level playing field?

To Sen. Hillary Clinton: You accurately identified the problem with private insurers, how they make a profit by either trying to “avoid insuring you” or “try[ing] to avoid paying for the health care you receive.” But the 1993 health care plan you supported solely relied on private insurers to deliver health care coverage. Will you commit to offering some sort of public plan so we can reduce our reliance on private insurers?

To Sen. Barack Obama: The principles you laid out appear to track the plan that John Edwards has offered. In fact, you called Edwards’ plan “very credible.” What can you propose that would improve upon the Edwards plan?

To Gov. Bill Richardson and Sen. Chris Dodd: Are you actually pledging to achieve universal coverage, or are you only offering universal “access” to coverage, which will allow some to fall through the cracks?

To Rep. Dennis Kucinich: You make a compelling case for an immediate move to a single-payer system, but how do you convince those Americans who are content with their coverage that such a system won’t take away what they have?

To Sen. Joe Biden: The Nevada Caucus 2008 blog checks your past statements and concludes you chose not the attend the forum because you’re not really for universal coverage. Is that true?

To the Republican candidates, who all skipped the forum: Do you really think you can win the White House if you won’t take public questions on what you’re going to do about our health care crisis?

Extra benefits of Medicare Advantage plans

Medicare Advantage in 2007

CMS (Centers for Medicare and Medicaid Services)

In 2007, the Medicare Advantage program is providing an affordable, high value choice for all Medicare beneficiaries.

The value and availability of plans is a direct result of Congressional policies establishing minimum rates for MA plans in some regions where the MA option was not yet available. These policies were established to ensure wide availability of MA plans and to do so, in part, by providing extra benefits to enrollees.

Plans, even those without networks of providers, can work directly with providers and beneficiaries, as many disease management companies do to ensure they receive appropriate follow-up and preventive services.

It is difficult to build these programs into the FFS program. Providers are not expected to coordinate care across settings or over time with patients after they leave their specific setting of care. It would require the program to pay either a care management organization separate from the delivery system to manage the patient or to pay physicians or others for these services.

http://www.cms.hhs.gov/HillNotifications/downloads/MedicareAdvantagein2007.pdf

And…

Low-Income and Minority Beneficiaries in Medicare Advantage Plans, 2004

AHIP (America’s Health Insurance Plans)
February 2007

The two main reasons that beneficiaries cited for choosing Medicare Advantage plans in 2004 were: (1) Lower costs (cited by 34 percent), and (2) Better benefits and coverage (cited by 21 percent) than fee-for-service Medicare.

http://www.ahip.org/content/fileviewer.aspx?docid=19240&linkid=165238

And…

The Facts: Medicare Advantage

Galen Institute
March 22, 2007

This fact sheet was jointly prepared by health policy experts from the American Enterprise Institute, the Center for Medicine in the Public Interest, the Galen Institute, The Heritage Foundation, the Institute for Policy Innovation, the Institute for Research on the Economics of Taxation, the National Center for Policy Analysis, the Pacific Research Institute, and Project Hope.

Wouldn’t it be better to simply add to traditional Medicare the extra benefits that Medicare Advantage plans offer?

Traditional Medicare pays for acute care after patients are ill and for some preventive services. Medicare Advantage plans offer added services for prevention and early detection of disease, and they are better able to provide coordinated medical care. This is the 21st century approach to medical care that the commercial market is finding offers better care at lower long-term costs.

One of the most critical issues in the future is how the Medicare program will address the growing numbers of beneficiaries with chronic conditions. In the traditional Medicare program, this responsibility either has to be taken on by one of the beneficiaries’ many providers, or by a separate entity that would need to coordinate with the variety of providers and with the beneficiary. Medicare cannot duplicate this role of MA plans by simply adding more services such as preventive care, more comprehensive drug coverage, and dental and vision care to the Medicare payment schedule. A strong MA program provides the best opportunity for creating a program to meet the growing need for coordinated care.

http://www.galen.org/medicare.asp?DocID=997

Comment:

By Don McCanne, MD

To advance the conservatives’ agenda of privatizing Medicare, private health plans had to be enticed to submit bids by being offered an average of an additional twelve percent over the costs of providing care within the traditional FFS (fee-for-service) Medicare program. In turn, the private plans could use a modest portion of this higher payment to offer greater benefits to entice patients to join the plans. It worked. Nineteen percent of Medicare beneficiaries are now enrolled in these private Medicare Advantage plans, and they are enjoying greater benefits as a result.

This higher payment has been characterized as an overpayment to the plans, and it is, when considering that most of it is used by the insurers for their own intrinsic purposes and not for patient care. But that portion which expands benefits is appropriate, except that it is very unfair. The other four-fifths of Medicare beneficiaries should be receiving the same enriched benefit package.

The administration, the insurance lobby, and the conservative think tanks are all pleading to stop the efforts to reduce these higher payments, correctly demonstrating that individuals enrolled in these Medicare Advantage programs will lose benefits. The solution is obvious. Payments required to maintain these benefits should be preserved, but the extra payments wasted by the insurers should be eliminated. And for fairness, the same extra benefits should be granted to everyone remaining in the traditional FFS Medicare program. The funds wasted by the Medicare Advantage plans would go a long way toward payment for the enrichment of benefits for everyone.

Understanding that this position might be taken by some of us who are more concerned about patients than insurers, the proponents of private plans have also countered with the claim that only they can provide coordinated care through care management services. CMS states that coordinated care services could be provided through the traditional FFS Medicare program only by requiring the program “to pay either a care management organization separate from the delivery system to manage the patient or to pay physicians or others for these services.”

To be sure we understand what they are saying, maybe we should expand on that last statement. If we want our traditional Medicare program to provide coordinated services then either we are going to have to hire managed care organizations and their administrators to manage the medical care of the patients, or we are going to have to pay primary care physicians appropriate compensation to manage medical care.

Everyone agrees that we need to reinforce our primary care infrastructure. Maybe this is the way to do it. Start paying primary care physicians and practitioners designated fees for the job that they were trained to do – coordinating the care of their patients. They could do it for a lot less than the wasteful, private Medicare Advantage plans. And they would do it while injecting a full dose of humanity – a product that private insurers can’t deliver.

Winds of change carrying cries for health care toward the Hill

Lance Dickie
Seattle Times | Editorial Columnist
Friday, March 23, 2007

Here is an unadorned fact of political life: An anxious middle class makes things happen, which explains the persistent drum beat of national interest in universal health-insurance coverage. People are uneasy.

The exact shape of the change to come is not clear, but more and more Americans are eager to listen to the options. One of the most straight-forward, and familiar, is national single-payer health insurance.

Everyone keeps their own doctors. Or more to the point, everybody can have one. Health care via physicians, nurses, hospitals, clinics, tests and technicians does not change. The caregivers are not employed by Uncle Sam.

Instead of having private insurance, everyone pays something into a common fund, and government writes the checks. Maybe it is the federal government that pays the bills, or states could be given the cash to devise a payment system that works best closest to home.

The revolution is in financing and reimbursement, not health-care delivery.

All the more curious is this uneasy mood occurring in what are understood to be recession-free, stable economic times of low unemployment.

Not long ago, the observation that unpaid medical bills are the No. 1 cause of personal bankruptcy might have been mildly interesting, like the unemployment rate if you have a steady job. Instead there is an unsettling recognition of vulnerability.

The middle class watches as medical benefits are cut as they grow more expensive or are lost altogether. Parents worry about grown children going without insurance because of the cost or employers who do not provide it.

Two short generations out from broad employer-based coverage, grandchildren come into the world without the neo-natal talisman of economic stability, a health-insurance card.

Two things are happening. In huge numbers, voters — a key word — are telling pollsters they think the federal government should guarantee health insurance. They are willing to pay higher taxes and forego tax cuts for the coverage, according to a recent New York Times/CBS News Poll.

Politicians hear the rumblings, and they are reacting in state capitals and on Capitol Hill with ideas and plans, many of which have been around a while. The stunning reversal of fortune for Congressional Republicans helped with the sensitivity training.

Last Friday on an unseasonably balmy evening, 300 people were in Kane Hall on the University of Washington campus to offer a rock-star welcome to three leaders working to provide universal health care. Given the topic and the weather, it was like packing Key Arena.

Rep. Jim McDermott, D-Seattle, and Dr. Quentin Young, co-founder of the Chicago-based Physicians for a National Health Program, have seen the political climate and national conversation turn in their direction. At the heart of both their optimistic talks was the need for public education.

Young, a wise-cracking octogenarian praised as a policy bulldog, works to keep the essence of single-payer simple. Repeat after him: Everybody in. Nobody out.

McDermott is equally tenacious. He first introduced his single-payer legislation in 1992. Bloodied but unbowed by the health-care debacle of the Clinton years, McDermott sees versions of his federal bill sprout in legislatures around the country. In a telephone call this week, McDermott said he sees the activity in the states as part of a welcome ferment that will help drive action at the national level.

The other significant change in the dynamic for universal health care is the interest being shown by major employers and labor unions. Over time, he expects state efforts and business support to point toward a single universal national plan.

Rep. Sherry Appleton, D-Poulsbo, was given an award by the Northwest chapter of Young’s group, for her work on The Washington Health Security Trust, which is dead for this session. A good idea, it will be back. Washington has 643,000 people without health insurance, 15 percent of the 43 million Americans without any coverage. Millions more have inadequate insurance.

State by state or via Washington, D.C., anxious Americans are demanding change. In this atmosphere, no credible presidential candidate can afford to be without a coherent health-insurance plan.

Lance Dickie’s column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com

Copyright (c) 2007 The Seattle Times Company

Union fights health horrors

By Gregory Lopes
Washington Times
March 23, 2007

America’s largest organized labor union is setting the stage for a campaign to reform the country’s health care system.

The AFL-CIO’s Working America, an affiliate of the union, this week set up the Web site: “Health Care Hustle.”

The site is a public forum for medical horror stories from the country’s health care system. “We’re getting hustled by powerful interests who don’t want to pay their fair share for real reform,” said Working America Director Karen Nussbaum.

The Web site already has 550 health care horror tales posted. The stories assess blame for health care hardships, whether it’s special-interest organizations such as the pharmaceutical lobby and insurance companies or the Bush administration.

At the end of the year, Working America will tally the “evildoers” in each story and create a media campaign targeted at that entity.

“We’re going to take the power of the people combined with the institutional power of the AFL-CIO and teach the evildoers a lesson. We think they will feel the pressure,” said Ms. Nussbaum.

The AFL-CIO is not part of a recent health care collaboration between the Service Employees International Union and corporate giants such as Wal-Mart. Ms. Nussbaum said that plan takes the wrong path to universal health care by shifting too many medical expenses to workers. Instead, she said a universal health care system must be built on the government-run Medicare program.

Using Web-based weapons is a new tactic for trade unions that, not long ago, were able to wield influence through numbers rather than technology. But federal statistics released this month show national union membership for 2006 at 12 percent of wage and salary workers, down from 12.5 percent in 2005 and 20.1 percent in 1983.

The illusion of private insurance coverage

The Illusion of Coverage: How Health Insurance Fails People When They Get Sick

By Carol Pryor, Andrew Cohen and Jeffrey Prottas
The Access Project
March 2007

The purpose of this study is to investigate the gaps in coverage and the systemic problems that cause insured people to accrue medical debt, as well as the consequences of the debt for individuals and families.

Findings

Our interviews suggest that medical debt among the insured results from a variety of causes and the interaction of a number of factors, including the adequacy of people’s insurance plans, the nature of their medical needs, the cost of their treatments, and their financial resources. In all cases, however, interviewees found that their insurance failed to fulfill its primary function – to protect them from financial losses and guarantee access to needed care when they became ill.

Insurance Characteristics that Cause Medical Debt

* Premiums, deductibles and other cost sharing.
* Caps on coverage.
* Uncovered services.

Insurance Processes that Cause Medical Debt

* Confusing policy provisions.
* Out-of-network fees.
* Procedural problems.
* Insurance disputes and errors.
* Complex provider billing and collections systems that compounded problems
resulting from complex insurance processes.

Lack of Meaningful Choice of Plans

* No real choice of plans.
* Increasing costs and worsening coverage.
* Higher premiums and levels of cost sharing.
* Pre-existing condition exclusions.
* Deceptive marketing practices.

Consequences of Medical Debt

* Access to care.
* Financial consequences.
* Employment consequences.
* Access to credit.
* Psychological consequences.

Conclusion

With health care costs and the number of people without insurance rising out of control, health care analysts and state and federal policy-makers are again focusing on ways to repair our health care system. Some of the proposals that have been offered are based on theoretical notions of what ails our system and what will fix it – people don’t pay enough of their medical costs to become informed consumers, state mandates require insurers to provide too much coverage, people should be allowed to purchase only the health insurance they need. However, serious proposals should be based not only on theory, but on real experiences of real people.

Numerous surveys have clearly documented that, in fact, many uninsured and insured people face unaffordable medical bills and crushing medical debt that undermines both their health and their long-term financial security. This report has attempted to put a face on those numbers. It has tried to show the often devastating effects of medical debt on individuals and families who thought they were secure because they were insured, but found out that their insurance did not protect them when they needed care. As we look for ways to decrease the number of uninsured, we should not replace one problem with another. People need coverage, not the illusion of coverage. We must guarantee that they have access to quality, affordable insurance that provides real protection when they are most in need.

http://www.accessproject.org/adobe/the_illusion_of_coverage.pdf

Comment:

By Don McCanne, MD

This report is important. It shows through the personal experiences of real people the severe deficiencies of our private insurance plans. Those who have significant health care needs are sounding the alarm for many of the rest of us who are complacent in believing that our private plans will provide us with adequate financial protection should we ever need to rely on them. Sadly, this report confirms that today’s health insurance plans frequently provide only the illusion of coverage.

There is one problem with this report, and that is with its recommendations. After identifying the major deficiencies of private health coverage, the authors make numerous specific recommendations to correct these deficiencies. They call for comprehensiveness, limited out-of-pocket expenses, guaranteed issue, guaranteed renewability, community rating, insurer efficiency, ombudsmen for dispute resolution, and regulatory oversight of unfair insurance practices. But just imagine what that would do to private insurance premiums under our current multipayer system. Talk about unaffordable!

So what do the authors suggest? They recommend public hearings on insurers’ requests for premium increases, as if talking about skyrocketing costs would control them. When that doesn’t work, to protect people with unaffordable medical expenses they would “require hospitals and other providers to offer appropriate discounts and financial assistance.” Really? The private insurance model is irreparably flawed. It’s time to give up on it.

A single payer system of national health insurance would eliminate all of the problems listed in the findings of this report – except one. We would lose our choice of health plans. Instead of choosing between thousands of plans with unaffordable premiums and inadequate protection, we would be limited to only one plan that really does work.