PNHP

How many are uninsured?

How many are uninsured?

Early Release of Selected Estimates Based on Data From the 2006 National Health Interview Survey

CDC
June 2007

In 2006, the percentage uninsured at the time of interview was 14.8% (43.6 million), which was not significantly different from the 2005 estimate of 14.2% (41.1 million).

http://www.cdc.gov/nchs/data/nhis/earlyrelease/200706_01.pdf

CDC: About 2M More Americans Uninsured

Associated Press
June 26, 2007

The number of adults without health insurance jumped by 2 million from 2005 to 2006, according to a new federal report. Uninsured Americans numbered 43.6 million last year, a 6 percent increase from 2005, according to the U.S. Centers for Disease Control and Prevention.

http://www.nytimes.com/aponline/us/AP-Uninsured.html

US survey lowers uninsured numbers to 43.6 million

Reuters
June 25, 2007

Just under 44 million Americans had no health insurance in 2006, according to a survey by the U.S. Centers for Disease Control and Prevention released on Monday. Their survey of 100,000 Americans is lower than previous federal estimates of 46 million.

http://www.alertnet.org/thenews/newsdesk/N25234092.htm

Census Bureau Revises 2004 and 2005 Health Insurance Coverage Estimates

U.S. Census Bureau
March 23, 2007

The revised estimates show that, in 2005, 44.8 million people, 15.3 percent of the population, were without health insurance — about 1.8 million fewer than the Census Bureau reported in August 2006 (46.6 million, 15.9 percent).

The Census Bureau discovered the need for a revision during a conversion to a more accurate operating system for the Current Population Survey.

http://www.census.gov/Press-Release/www/releases/archives/health_care_insurance/009789.html

Comment:

By Don McCanne, MD

How many in the United States are uninsured? According to the 2006 National Health Interview Survey (NHIS) just released, 43.6 million are uninsured, an increase of 2.5 million from 2005. But the CDC states that the 2.5 million increase was “not statistically different” from 2005. The Associated Press reported this as an increase in the numbers of uninsured, and Reuters reported it as a decline. Even the U.S. Census Bureau has problems with its estimates, having recently revised the 2005 numbers from 46.6 million down to 44.8 million.

This does not stop others from manipulating these numbers further. Conservative groups have suggested that many of the uninsured should be ignored for various reasons, and that the uninsured status is only of concern for less than 10 million individuals. Progressive groups have suggested that these counts understate the severity of the problem in that, over a two year period, more than 80 million individuals are without insurance at some point during that time.

In a few weeks (August) the Census Bureau will release the Current Population Survey for 2006. For purposes of the reform dialogue, those will be the most reliable numbers.

The point is that we cannot let others change the debate by zeroing in on the problems with counting the numbers of uninsured. The real issue that needs to be addressed is that we have a health care financing system that is a disaster for the uninsured and for many of the the insured with health care needs.

We do not need to get into a food fight over the precise numbers of uninsured. There are a lot of them, and many are suffering physically and financially, and some are even dying. And a great many more of those who are victims actually have insurance. Do not let the opponents of reform divert you from this crucial message into a silly numbers game.

Health care film exposes sore issue

Whether for or against reform, industry experts are eager to watch 'Sicko'

By Daniel Lee and John Russell
The Indianapolis Star
June 27, 2007

When controversial filmmaker Michael Moore’s blistering critique of the U.S. health care system hits Indiana theaters Friday, a Hoosier group that supports a government-run health care system will be waiting outside in search of converts.

“For our point of view, the timing is terrific,” said Dr. Christopher Stack, a retired Indianapolis surgeon who co-founded Hoosiers for a Commonsense Health Plan, a group that advocates for government-run health care. “It will get people talking.”

The group couldn’t agree more with Moore’s prescription — a move that would guarantee coverage for every American and presumably put Indianapolis-based WellPoint and other health insurance companies out of business.

Members of Stack’s group — including health care workers who will be encouraged to wear their medical scrubs — plan to be at theaters in Bloomington and maybe Indianapolis handing out literature and chatting up moviegoers.

Stack hopes the movie generates broad public and political support for a government-run health care system. “It’s never been taken seriously by the powers that be,” he said.

Love him or hate him, Michael Moore is focusing debate about health care in the United States.

And the movie’s message is expected to stir emotions, especially in the Indianapolis area — home to the nation’s largest health insurer, WellPoint; pharmaceutical giant Eli Lilly and Co.; and thousands of other health-industry workers.

WellPoint and Lilly are not featured prominently, but their industries are portrayed as more focused on profits than patients.

The film features allegations that WellPoint’s Blue Cross of California subsidiary had a systematic practice of illegally canceling some members’ policies after they got sick. The company has denied any wrongdoing.

Lilly is not verbally mentioned in the film; the only reference is a fleeting image of a Lilly corporate building sign during a broad attack on the U.S. drug industry for its support of the Medicare prescription drug law of 2003.

Other insurers featured include Louisville, Ky.-based Humana and Philadelphia-based Cigna.

“Sicko” focuses on a string of health care horror stories from Americans, contrasted by idealized portraits of nationalized health care systems in Canada, France, Great Britain and even Cuba.

Critics slam Moore for his style of filmmaking, which they say is agenda-driven and based on carefully selected facts. America’s Health Insurance Plans, an industry trade group that represents WellPoint and others, said neither Moore nor his staff contacted any of the companies mentioned in the movie to get their side of the story.
But even some in health care who may not agree with Moore seem eager to see the film.

“I do look forward to seeing it. That’s what I do for a living,” said Matt Gutwein, chief executive of the Marion County Health and Hospital Corp., which runs Wishard Memorial Hospital. “I do think our system is broken. I think it’s unsustainable in its current course.”

However, Gutwein blames the structure of the U.S. health care system, not the health insurers themselves.

“The vast majority of insurance companies, they play by the rules,” he added. “And they’re not the ones who made those rules.”

WellPoint, in response to the movie, said any reform of the U.S. health care system should be based on consumer choice, not a “one-size-fits-all” system. “Given our millions of members, our trusted Blue and UniCare brands, and our interactions with patients and doctors, WellPoint is in a great position to help make the system work,” spokesman Jim Kappel said.

“Sicko,” however, portrays WellPoint in a different way. The company’s Blue Cross of California unit was accused of canceling some members’ policies after they got sick and ran up high medical bills. The company, which denied any wrongdoing, this year settled a class-action lawsuit stemming from the controversy.

The members had claimed that WellPoint would review members’ insurance applications after they got sick looking for any untruth or undisclosed medical condition to deny their claims.

“Sicko” portrays one woman who said her policy was canceled because she had not disclosed a prior yeast infection.

The drug industry also comes under attack from Moore when he compares prescription drug prices in the U.S. to those elsewhere. Moore discovers that an inhaler that would cost an American with a respiratory disease $120 in the U.S. is available in Cuba for about 5 cents, although he does not verify that the medicine is identical or even Food and Drug Administration-approved.

Eli Lilly, long known for supporting free-market health care, takes issue with Moore’s sweeping push for a government- managed health care system.

“These government systems have been given numerous chances to work in other nations, and evidence suggests they are far from ideal,” the company said in a statement. “A single-payer system eliminates competition and hinders quality improvements by slowing the pace of innovation.”

Regina Herzlinger, a professor at the Harvard Business School, said despite its shortcomings, “Sicko” taps into an issue that is ripe for debate.

“It’s disgusting that a country as rich as ours doesn’t have insurance for everybody,” said Herzlinger, also a senior fellow at the Manhattan Institute, a New York think tank.

But she has major disagreements with Moore’s promotion of a government takeover of health care. “I don’t want the government to run it. I want you and me to run it.”

Herzlinger advocates having employers no longer providing workers with health insurance as a benefit. Citizens would be required to buy insurance, with rates depending on a person’s age, sex and location, with no one excluded for a pre-existing condition. Subsidies would be available for the poor.

Local health reform advocate Stack envisions a Medicare-like insurance plan for all Americans.

That debate is likely to rage on long after “Sicko” has had its run.

Good Movie, Now Where's the Movement?

Sicko and the Politics of Health Care

By RALPH NADER
June 26, 2007

He sat there dejected and indignant-twenty years ago-in our office. His position as editor of the monthly muckraking magazine, Mother Jones, had broken up. He was looking for a job that would allow him to bring his conscience to work.

We gave him a place and support to start Moore’s Weekly-a media critique.

Michael Moore has gone a long way since that short-lived publication. He went on to do documentary films, starting with Roger and Me-meaning of course, Michael Moore.

Rich, famous and Hollywood chic, Moore will open his latest film-‘Sicko’ in theatres around the country on June 29, 2007. To many of those who have already seen this indictment and conviction of the corporations that sell health care under an array of tricky conditions, it is his best move yet.

He was in Washington, D.C. last week, for a preview at the large Uptown Theatre and for testimony before a House Committee. The media followed him with a frenzy hitherto reserved for Paris Hilton.

But Michael Moore is no Paris Hilton from any dimension you wish to choose. He is a heavyweight reformer, pitching his film toward full Medicare for everyone. This also means displacing the health insurance industry the way Medicare partially did in the mid-Sixties for the elderly.

“I think one movie can make a difference;.I believe it will be a catalyst for the type of real change people want,” Moore told the New York Times.

Great movies and documentaries raise people’s latent indignation levels-for a short time. Norma Rae, The China Syndrome and The Grapes of Wrath had this effect. But films do not usually move either people or legislators to action. Their effect does not reach enough people. Their urgent 2 hour impact tends to diminish quickly, as compared with the omnipresent and powerful corporate or commercial interests determined to preserve the status quo.

Will ‘Sicko’ be any different? Certainly the giant HMOs, hospital chains and drug companies are firmly entrenched with all the sinews of power that have left this country, alone among western nations, without health care for all. They have endured easily many mainstream print and television exposés (see the New York Times, AP, 60 Minutes and the nightly evening news, for example) year after year.

Authoritative reports documenting over $200 billion a year in computerized billing fraud and abuse or the loss of 18,000 American lives yearly due to the unaffordability of health care (The Institute of Medicine) bounce off this two trillion dollar industry like marshmallows.

Having been a taught community organizer in Michigan, (see the new book, Citizen Moore by Roger Rapaport) Moore has prepared with all this in mind. He allied himself with the great California Nurses Association and their nationwide colleagues to demonstrate in favor of the film, contact legislators and other large unions.

The anticipatory media for the movie have been generous; citing the U.S. government’s move against Moore for what it claims was an unauthorized trip to Cuba. Right wing think tanks, funded by this hyper-profitable, subsidized industry, pour out inane rebuttals and offer quotes against Moore for reporters.

Unlike for other social justice movies, there is even a bill in Congress, H.R. 676 with 74 cosponsoring legislators, led by Cong. John Conyers (Dem. Mich.), to establish full Medicare for all.

That is a number of lawmakers considerably less that those who signed on to a similar bill in 1993.

There are 17 million more Americans uninsured today than in that year, totaling nearly 48 million without coverage in 2006. So you see where that trend is heading.

If Moore is serious about getting “real change,” as he phrases his goal, he will have to make at least two more contributions. First, he will need to make a comprehensive effort to get many of the 6 million or more people, who will see the film, to sign up as they enter or leave the theatres so that they can be given a chance to connect with each other for a cohesive change constituency.

Secondly, some of the millions he will make from this movie should be put into a full time lobbying organization in Washington and back in the Congressional districts to press for enactment of H.R. 676.

With all his super-rich Hollywood contacts and admirers, Moore should be able to multiply this proposed group’s budget several fold. Michael can even call it ‘Moore’s Miracle!’

Good Movie, Now Where’s the Movement?

Sicko and the Politics of Health Care

By RALPH NADER
June 26, 2007

He sat there dejected and indignant-twenty years ago-in our office. His position as editor of the monthly muckraking magazine, Mother Jones, had broken up. He was looking for a job that would allow him to bring his conscience to work.

We gave him a place and support to start Moore’s Weekly-a media critique.

Michael Moore has gone a long way since that short-lived publication. He went on to do documentary films, starting with Roger and Me-meaning of course, Michael Moore.

Rich, famous and Hollywood chic, Moore will open his latest film-‘Sicko’ in theatres around the country on June 29, 2007. To many of those who have already seen this indictment and conviction of the corporations that sell health care under an array of tricky conditions, it is his best move yet.

He was in Washington, D.C. last week, for a preview at the large Uptown Theatre and for testimony before a House Committee. The media followed him with a frenzy hitherto reserved for Paris Hilton.

But Michael Moore is no Paris Hilton from any dimension you wish to choose. He is a heavyweight reformer, pitching his film toward full Medicare for everyone. This also means displacing the health insurance industry the way Medicare partially did in the mid-Sixties for the elderly.

“I think one movie can make a difference;.I believe it will be a catalyst for the type of real change people want,” Moore told the New York Times.

Great movies and documentaries raise people’s latent indignation levels-for a short time. Norma Rae, The China Syndrome and The Grapes of Wrath had this effect. But films do not usually move either people or legislators to action. Their effect does not reach enough people. Their urgent 2 hour impact tends to diminish quickly, as compared with the omnipresent and powerful corporate or commercial interests determined to preserve the status quo.

Will ‘Sicko’ be any different? Certainly the giant HMOs, hospital chains and drug companies are firmly entrenched with all the sinews of power that have left this country, alone among western nations, without health care for all. They have endured easily many mainstream print and television exposés (see the New York Times, AP, 60 Minutes and the nightly evening news, for example) year after year.

Authoritative reports documenting over $200 billion a year in computerized billing fraud and abuse or the loss of 18,000 American lives yearly due to the unaffordability of health care (The Institute of Medicine) bounce off this two trillion dollar industry like marshmallows.

Having been a taught community organizer in Michigan, (see the new book, Citizen Moore by Roger Rapaport) Moore has prepared with all this in mind. He allied himself with the great California Nurses Association and their nationwide colleagues to demonstrate in favor of the film, contact legislators and other large unions.

The anticipatory media for the movie have been generous; citing the U.S. government’s move against Moore for what it claims was an unauthorized trip to Cuba. Right wing think tanks, funded by this hyper-profitable, subsidized industry, pour out inane rebuttals and offer quotes against Moore for reporters.

Unlike for other social justice movies, there is even a bill in Congress, H.R. 676 with 74 cosponsoring legislators, led by Cong. John Conyers (Dem. Mich.), to establish full Medicare for all.

That is a number of lawmakers considerably less that those who signed on to a similar bill in 1993.

There are 17 million more Americans uninsured today than in that year, totaling nearly 48 million without coverage in 2006. So you see where that trend is heading.

If Moore is serious about getting “real change,” as he phrases his goal, he will have to make at least two more contributions. First, he will need to make a comprehensive effort to get many of the 6 million or more people, who will see the film, to sign up as they enter or leave the theatres so that they can be given a chance to connect with each other for a cohesive change constituency.

Secondly, some of the millions he will make from this movie should be put into a full time lobbying organization in Washington and back in the Congressional districts to press for enactment of H.R. 676.

With all his super-rich Hollywood contacts and admirers, Moore should be able to multiply this proposed group’s budget several fold. Michael can even call it ‘Moore’s Miracle!’

The political priority of EMRs

Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices

By Jesse C. Crosson, PhD, Pamela A. Ohman-Strickland, PhD, Karissa A. Hahn, MPH, Barbara DiCicco-Bloom, RN, PhD, Eric Shaw, PhD, A. John Orzano, MD and Benjamin F. Crabtree, PhD
Annals of Family Medicine
May/June 2007

We assessed the relationship between electronic medical record (EMR) usage and diabetes care quality in a sample of family medicine practices.

…patients with diabetes in practices that did not have an EMR were significantly more likely to have received care that met the guidelines for processes of care, treatment, and intermediate outcomes. For intermediate outcomes, the odds of patients in non-EMR using practices meeting all 3 targets was 2.68 times the odds of patients in EMR-using practices.

http://www.annfammed.org/cgi/content/full/5/3/209

Comment:

By Don McCanne, MD

Those politicians touting electronic medical records (EMRs) as a major component of their reform proposals should take note of this study. Diabetic patients in family practices that did not use EMRs received better care than those in family practices that did.

This is not to say that EMRs are necessarily bad. The experience in the VA health system has been that government-developed EMRs (Vista) assist physicians in improving compliance with accepted standards of care.

The crucial difference is that private practices use competing commercial vendors who are concerned more about gaining market share with systems designed to maximize profits, both for the vendors and for the physicians. The EMR vendors emphasize features such as enhanced billing functions.

In contrast, government-developed systems are designed to enhance quality. In fact, a very modest investment of public funds could be used to adapt the VA’s Vista EMR system into a low-cost, high quality system for the private health care delivery sector (but only after patient privacy issues have been resolved).

In the meantime, instead of protecting the dysfunctional private insurance industry by diverting the debate to peripheral issues such as information technology, the politicians should tackle the most urgent problem head on. We need to fix the way we pay for health care so that everyone can have the care they need without facing financial hardship.

Political status of insurance mandates in California

Top Democrats, governor tout health care proposals

By Aurelio Rojas
The Sacramento Bee
June 22, 2007

Setting the stage for negotiations to begin in earnest, Democratic legislative leaders announced Thursday they have combined their proposals to expand health care in California.

Senate President Pro Tem Don Perata, D-Oakland, and Assembly Speaker Fabian Núñez, D-Los Angeles, previously agreed to require employers to spend 7.5 percent of payroll costs on health care, but differences remained.

In the biggest compromise, Perata agreed with Núñez to reject Republican Gov. Arnold Schwarzenegger’s proposal that everyone in the state be required to obtain insurance.

At an earlier news conference at the home of a small-business owner in Sacramento, where he touted his health care plan, Schwarzenegger held firm that employees be required to contribute.

“The only way that health care reform is going to work is if you have mandatory health care insurance,” said the governor.

In the coming weeks, the debate will focus on who would pay for health care expansion — and how much.

The Democrats and Schwarzenegger agree on requiring employers to help foot the bill. They also support creating a state-run insurance pool, mandating that insurance companies cover anyone who applies, and providing subsidies to the poor.

In agreeing to merge their plans, Perata and Núñez made some important decisions.

The state-run pool for high-risk individuals would be funded by an unspecified assessment on health plans under their proposal.

http://www.sacbee.com/111/story/235862.html

And…

Governor’s plea to insurers

By Kevin Yamamura
The Sacramento Bee
June 23, 2007

Gov. Arnold Schwarzenegger asked the nation’s health insurers Friday to provide coverage to all people, regardless of condition, and to devote more revenue to health care than administrative costs.

The Republican governor spoke at the America’s Health Insurance Plans Institute conference in Las Vegas, selling his health plan to cover 6.5 million uninsured Californians as a potential model for the rest of the nation.

Schwarzenegger received the biggest applause Friday when he declared that backers of single-payer universal health care are “absolutely wrong.”

“We want everyone to have access to coverage,” he said. “No one should be turned away because of age or because of some medical history. And if people cannot afford their insurance, of course government should be taking care of them and help them to get insurance. But if they can afford it, then you should sell it to them.”

The governor listed six insurers in California that back the idea of guaranteed coverage for individuals as long as it comes with a statewide mandate that everyone have health insurance.

But he did not name the state’s largest health insurer, Blue Cross of California, which covers more than 8 million state residents.

The company does not support a requirement to cover every individual regardless of condition. Instead, Blue Cross spokesman Nick Garcia said the state should expand its coverage of individuals through its high-risk pool. He warned that premiums would rise if California imposes a guaranteed coverage requirement on insurers.

http://www.sacbee.com/111/story/237564.html

Comment:

By Don McCanne, MD

Private health plans are obsolete. Even when insurers are successful in selling their plans to fairly healthy populations (employer-sponsored plans and medically-underwritten individual plans), health costs are now so high that they are unable to create a reasonably comprehensive insurance product that has premiums that are affordable for average- and low-income individuals, the majority of the population. Employer sponsorship has kept the plans alive, but that source is becoming evermore strained.

The California Democratic leadership, Speaker Nunez and President Pro Tem Perata, introduced similar bills, with one very important difference. Though they both included an employer mandate, Perata’s bill also included an individual mandate. When it was clear that you cannot require individuals to purchase a plan that they cannot afford, they agreed to drop the individual mandate. But that would leave a few million Californians without coverage.

In an effort to make private plans more affordable, in order to encourage voluntary purchase of the plans, they agreed to move high-cost patients into a state-run high-risk pool. But they would fund that with assessments on private plans, which would necessitate much higher premiums, especially in those plans which have risk pools limited to the very healthy, such as Blue Cross’ Tonik plans. Segregating and then indirectly recombining risk pools does nothing to make private plan premiums more affordable.

Ironically, it is Republican Governor Schwarzenegger who is insisting that everyone be covered. He believes that not only is it the right thing to do, but he also acknowledges that insurance doesn’t work for those with health care needs unless they are pooled together with the many who are healthy. He also understands that the government must be involved in obtaining insurance for those who cannot afford it. But he does not want any net increases in taxes over the current level of funding of public programs.

Gov. Schwarzenegger also understands that his proposal for an individual mandate breaks down if the insurance industry is unable to produce effective insurance products with premiums that are affordable for average-income individuals. Supporting policy from his wish-it-were-possible list, he appeared before a conference of America’s Health Insurance Plans to issue a plea for them to produce the mythical affordable plan for the majority of Californians.

Health care costs are now too high for average-income individuals to pay premiums that are set by the collective health care costs of the pool, plus added administrative costs, divided by the total number of participants in the pool, even when the pool has selected a relatively healthy population such as the workforce and their families. The private insurance model is obsolete.

It is not that we don’t have the money to pay for the care. We are already spending enough to fund comprehensive care for everyone. But we are stumbling over ourselves in trying to make private plans the funding vehicle when they no longer work. What we need is an equitable method of funding the health care pool. That would be a simple task if we would agree to establish a single universal pool and fund it through equitable, progressive taxes.

Keeping the obsolete model of private health plans in play merely because of a bizarre adherence to concepts of political expediency is not sound policy. Yet we continue to allow bad politics to trump good policy. Why?

Woolhandler testimony on uninsured veterans

Statement of Stephanie J. Woolhandler, MD, MPH, FACP, Associate Professor of Medicine, Harvard Medical School, and Co-Founder, Physicians for a National Health Program

House Committee on Veterans’ Affairs
June 20, 2007

Uninsured Veterans: A Stain on America’s Flag

Summary/Oral Testimony

In my written testimony I present detailed information on the health insurance coverage and problems in access to health care of America’s veterans, based on analyses of multiple years of data from two annual national surveys carried out by the government: The Current Population Survey and the National Health Interview Survey.

I will address two questions: (1) How many veterans are currently uninsured? And (2) Do uninsured veterans suffer problems in access to care — similar to other Americans who are uninsured?

In 2004, 1.8 million military veterans neither had health insurance nor received ongoing care at Veterans Health Administration (VHA) hospitals. Note that the surveys asked veterans if they had health insurance, and if they had veterans or military health care. We counted them as uninsured only if they answered no to both questions. The number of uninsured veterans has increased by 290,000 since 2000. The proportion of non-elderly veterans who were uninsured rose from less then one in ten (9.9%) in 2000 to more than one in eight (12.7%) in 2004.

An additional 3.8 million members of veterans’ households were also uninsured and ineligible for VHA care.

Virtually all Korean War and World War II veterans are over age 65 and hence covered by Medicare. However, 645,628 Vietnam-era veterans were uninsured (8.5% of the 7.56 million Vietnam-era vets). Among the 8.6 million veterans who served during “other eras” including the Persian Gulf War, 12.9% (1,105,891) lacked health coverage.

Almost two-thirds (64.3%) of uninsured veterans were employed and nearly nine out of ten (86.4%) had worked within the past year. Most uninsured veterans, like other uninsured Americans were in working families. Many earned too little to afford health insurance, but too much to qualify for free care under Medicaid or VA means testing.

Uninsured veterans have the same problems getting the care they need as do other uninsured Americans. Moreover, many uninsured veterans have serious illnesses requiring extensive care. Among uninsured veterans older than 45 years, nearly one in five (19.1%) were in fair or poor health. Nearly one in three uninsured veterans (of all ages) reported at least one chronic condition that limited their daily function.

A disturbingly high number of uninsured veterans reported needing medical care and not being able to get it within the past year. More than a quarter (26.5%) of uninsured veterans failed to get needed care due to costs; 31.2% had delayed care due to costs. Among uninsured veterans, 44.1% had not seen a doctor or nurse within the past year, and two-thirds failed to receive preventive care. By almost any measure, uninsured veterans had as much trouble getting medical care as other uninsured persons.

The VHA is a rare success story in our health care system. The VHA offers more equitable care and higher quality care than the average care in the private-sector, and has become a medical leader in research, primary care, and computerization.

While we support opening VHA enrollment to all veterans, this would still leave many veterans unable to access care because they live far from VHA facilities. Moreover, even complete coverage of veterans would leave 3.8 million of their family members uninsured. Hence, my colleagues and I support a universal national health insurance program that would work with and learn from the VHA system in covering all Americans.

Full oral and written testimony:
http://veterans.house.gov/hearings/schedule110/june07/06-20-07/6-20-07woolhandler.shtml

And…

Study Finds 1.8 Million Veterans Are Uninsured

By Christopher Lee
The Washington Post
June 21, 2007

Stephanie J. Woolhandler, the Harvard Medical School professor who presented her findings yesterday before the House Committee on Veterans Affairs… is a well-known advocate of guaranteeing access to health care for all Americans through a government-run national health insurance program. Republican lawmakers seized on that association to question whether she was trying to advance that goal with her study.

“The difficulty would be that because of your desire for universal health care, that could influence how you felt about veterans,” Rep. Cliff Stearns (R-Fla.) said.

Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen uninsured veterans with untreated high blood pressure, diabetes and other conditions.

“It breaks my heart,” she said.

http://www.washingtonpost.com/wp-dyn/content/article/2007/06/20/AR2007062002161.html?referrer=emailarticle

Comment:

By Don McCanne, MD

Mine too.

Study Finds 1.8 Million Veterans Are Uninsured

Figure Has Grown by 290,000 Since 2000, Professor Tells House Veterans Panel

By Christopher Lee
Washington Post Staff Writer
Thursday, June 21, 2007; Page A09

As the nation struggles to improve medical and mental health care for military personnel returning from Afghanistan and Iraq, about 1.8 million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found.

The ranks of uninsured veterans have increased by 290,000 since 2000, said Stephanie J. Woolhandler, the Harvard Medical School professor who presented her findings yesterday before the House Committee on Veterans Affairs. About 12.7 percent of non-elderly veterans — or one in eight — lacked health coverage in 2004, the most recent year for which figures are available, she said, up from 9.9 percent in 2000. Veterans 65 and older are eligible for Medicare.

About 45 million Americans, or 15 percent of the population, were uninsured in 2005, the Census Bureau reports.

“The data is showing that many veterans have no coverage and they’re sick and need care and can’t get it,” Woolhandler said.

Woolhandler’s findings are based on data from two national surveys — the Current Population Survey administered by the Census Bureau and the National Health Interview Survey administered by the Department of Health and Human Services. Veterans who said they had neither health insurance nor veterans or military health care were counted as uninsured.

Woolhandler is a well-known advocate of guaranteeing access to health care for all Americans through a government-run national health insurance program. Republican lawmakers seized on that association to question whether she was trying to advance that goal with her study.

“The difficulty would be that because of your desire for universal health care, that could influence how you felt about veterans,” Rep. Cliff Stearns (R-Fla.) said.

Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen uninsured veterans with untreated high blood pressure, diabetes and other conditions.

“It breaks my heart,” she said. “The VA should be an important safety net for my patients, and it’s not.”

Nearly 8 million veterans were enrolled in the VA health system in 2006. The focus of the hearing was whether to open VA hospitals’ doors to so-called Priority 8 veterans, who have no service-connected disabilities and whose earnings generally are above 80 percent of the median income where they live. Doing so would add significantly to VA’s caseload and costs — estimates range from $366 million to $3.3 billion annually — and some veterans groups and lawmakers are concerned that it would make it harder for veterans with serious service-related health problems to get timely care.

Only about half of the 1.8 million uninsured veterans are classified Priority 8, Woolhandler said. The rest may technically be eligible for some VA care but live too far from its facilities for it to be a real option, she said.

Rep. Steve Buyer (Ind.), the committee’s ranking Republican, said Veterans Affairs should focus on its “core constituency” — veterans with service-related health problems, the indigent and those with “catastrophic” disabilities. “Some say the government is obliged to provide essentially free health care for life to anyone who served even a year or two,” he said. “I intend to protect the core constituency first.”

But Rep. Bob Filner (D-Calif.), the committee’s chairman, said taking care of veterans is a continuing cost of war. “All veterans should have access to ‘their’ health-care system,” he said. “This is rationing health care to veterans, those who have served our nation. And I think it’s unacceptable for a nation of our wealth and our ability.”

PricewaterhouseCoopers on cost trends for 2008

Behind the numbers

Healthcare cost trends for 2008
PricewaterhouseCoopers
Health Research Institute

Based on discussions with private insurers, medical costs are expected to rise by 9.9% for preferred provider organizations (PPOs), 9.9% for health maintenance organizations (HMOs)/point of service plans (POSs)/exclusive provider organizations (EPOs), and 7.4% for consumer-directed health plans.

While too early to evaluate the long-term impact of consumer-directed health plans, it appears that their cost trend is running about 2.5 percentage points below cost trends in HMOs and PPOs. However, enrollment in these plans is still fairly low, and it’s probably too early to determine whether these plans can lower medical costs long term.

In looking at the year ahead, PricewaterhouseCoopers identified four influences that are affecting the cost trend:

* Slower spending growth for prescription drugs – A key factor in the lower growth rate is the increase in generic dispensing.

* Increased transparency and cost-sharing with employees – Higher co-pays, higher deductibles, and an increase in cost-sharing tiers for health plans are all a part of this general trend.

* Total-health-management approach to benefits – More employers are investing in wellness and are developing incentives for employee adoption of healthier lifestyles. Research has shown that some employers have received a $3 to $1 return on investment for preventive services and health promotion.

* Broadening of the digital backbone in healthcare – While initial spending on IT has been shown to add to costs, the longer-term effect is one of reduction in costs. While still in its early stages, the potential to improve quality and reduce variation in provider practice patterns will be strengthened as the digital backbone continues to strengthen.

The causes for the current deceleration are complex, but it’s clear that the movement into consumerism is real and is affecting medical costs.

http://pwchealth.com/cgi-local/hregister.cgi?link=reg/numbers2008.pdf

Comment:

By Don McCanne, MD

When health care costs continue to increase well in excess of the rate of inflation, it seems counter-intuitive to celebrate the success of the role of consumerism in the deceleration of the rate of health care cost increases. Furthermore, is the celebration of the success of consumerism even warranted? Let’s look at the four influences identified by PricewaterhouseCoopers.

* Prescription drugs – Many drugs are going off patent, resulting in a significant increase in lower-priced, FDA-approved generics. Whether it is the government, the private insurer, or the patient who is paying the bill, lower-priced generic equivalents are always preferred. Does anyone believe that this preference for value would not exist if it were not being pushed by the advocates of consumer-directed health care (CDHC)? How can anyone seriously contend that the increase in generics is a success of consumerism?

* Increased employee cost sharing – The primary impact of high deductibles, copayments, and coinsurance is to shift some of the responsibility of paying for health care from the employer to the employee. Most employees have difficulty understanding how the opportunity to pay more out-of-pocket for health care is of personal benefit to them. As a result, many forgo beneficial health care services. Policies that result in individuals not receiving the care that they should be can hardly be described as a success of consumerism. It is a failure of consumerism.

* Total-health-management – Can employers really influence the health habits of their employees? You often see cited the claim that employers receive a $3 return for each dollar spent on health promotion. I have never seen an objective study confirming this, but only the statement by Ron Finch, EdD that “for every $100 spent on health promotion, employers could see a $300 return on investment” (Compensation & Benefits Review, Vol. 37, No. 2, 18-22 (2005)). Could see a return is not the same as seeing a return. Although health promotion is to be commended, motivating individuals to exercise, eat well, quit smoking, practice safe sex, and otherwise positively modify their behavior has been one of the more difficult challenges for both the public health system and our health care providers. That employers could meet this challenge through the magic of consumerism is nonsense.

* Information technology – We are still in the primitive stages of development of IT in that we haven’t even crossed the first crucial threshold: assuring patient privacy in an interconnected system. It is unlikely that we will make any significant progress until we have leadership in the public sector that is ready to set the national standards required for an interoperable system. The startup and maintenance costs will be great, and they may never be offset by the savings through error reduction and other efficiencies. Since cost savings from information technology in health care does not yet exist, it can hardly be claimed as a success of consumerism.

We have already identified the excess cost drivers in health care, and we know how to reduce the waste while improving the effectiveness of our system. When the business community finally realizes that indulging themselves in their fantasies of consumerism is leading them nowhere, maybe they’ll finally be ready to join us in supporting reform that really will work: single-payer national health insurance.

Doctors agree that insurance matters

California Physician Survey 2007
By Peter D. Hart Research Associates, Inc.
California Medical Association

Q.15 Which one of the following do you think is the biggest impediment for people to get timely access to health care?

66% – Lack of health insurance
16% – Too few physicians
8% – Inability to pay co-pays and deductibles
10% – Other

Q.16 In general, how different is the quality of care that uninsured persons receive compared with the care that people with insurance receive–much lower quality, somewhat lower quality, the same quality, or higher quality?

41% – Much lower quality
42% – Somewhat lower quality
16% – The same quality
1% – Higher quality

http://www.cmanet.org/upload/ca_physician_survey_2007.pdf

Comment:

By Don McCanne, MD

Most of us cringe when we hear a physician state that being uninsured doesn’t prevent access to health care, noting that the emergency room is always available. This survey provides reassurance that most physicians do not share that view. When asked what the one single biggest impediment to access is, two-thirds of physicians state that it is the lack of health insurance. Though it is acknowledged that other factors are also important, being insured is absolutely crucial.

Physicians also understand that patients receive lower quality care when they lack insurance; 83 percent of physicians are in concurrence.

The one percent who believe that the uninsured receive higher quality care likely represent those who dismiss the access issue as well. As we continue our efforts to insure everyone, we can dismiss those making such outrageous claims, reassured that the overwhelming majority of physicians agree that health insurance really does matter.

Blue Healthcare Bank

BlueCross BlueShield Association
Blue Healthcare Bank

The Blue Cross and Blue Shield (BCBS) companies have launched a new financial services organization designed to give consumers greater financial options and to simplify their healthcare-related savings and spending.

Blue Healthcare Bank (SM) is a new concept for a new era in healthcare. It was created to support participating Blue Cross and Blue Shield companies and their members enrolled in high deductible health plans. Blue Healthcare Bank is wholly owned by participating independent Blue companies and the Blue Cross and Blue Shield Association.

Working seamlessly with participating Blue Cross and Blue Shield companies, Blue Healthcare Bank helps members make the most of their health, money and time by giving them the tools they need to simplify their healthcare financial decisions. Here’s just a sample:

Dependable service–Participating Blue companies and Blue Healthcare Bank work hand-in-hand. When members have questions, they won’t be calling a separate bank that doesn’t know if the call is about an auto loan or a healthcare account.

Everything healthcare consumers need in one place — Members enjoy all the advantages of integrated health insurance, healthcare information and healthcare financial services, brought together by their participating Blue companies and Blue Healthcare Bank.

Payment flexibility — Members receive dependable, flexible payment options that include state-of-the-art Blue Healthcare Bank debit cards, member self-reimbursement, checks and online bill payment.

Diverse HSA investment choices–Members with health savings accounts (HSAs) who meet health savings account balance requirements can invest in a wide range of mutual funds from leading fund families. These funds can be accessed and managed online.

HSA credit services — HSA account holder may be able to access credit services that enhance their HSAs, depending on whether their employer has selected these services and the account holder’s own creditworthiness.

http://www.bcbs.com/innovations/healthcare/

Comment:

By Don McCanne, MD

When they say it’s not about the money, it’s about the money.

America Comes Up Short

By PAUL KRUGMAN
New York Times
Published: June 15, 2007

Traveling through Europe recently, I’ve been able to confirm through personal experience what statistical surveys tell us: the perceived stature of Americans is not what it was. Europeans used to look up to us; now, many of them look down on us instead.

No, I’m not talking metaphorically about our loss of moral authority in the wake of Guantánamo and Abu Ghraib. I’m literally talking about feet and inches.

To the casual observer, Europeans — who often seemed short, even to me (I’m 5-foot-7), when I first began traveling a lot in the 1970s — now often seem tall by American standards. And that casual observation matches what careful researchers have found.

The data show that Americans, who in the words of a recent paper by the economic historian John Komlos and Benjamin Lauderdale in Social Science Quarterly, were “tallest in the world between colonial times and the middle of the 20th century,” have now “become shorter (and fatter) than Western and Northern Europeans. In fact, the U.S. population is currently at the bottom end of the height distribution in advanced industrial countries.”

This is not a trivial matter. As the paper says, “height is indicative of how well the human organism thrives in its socioeconomic environment.” There’s a whole discipline of “anthropometric history” that uses evidence on heights to assess changes in social conditions.

For example, nothing demonstrates the harsh class distinctions of Britain in the age of Dickens better than the 9-inch height gap between 15-year-old students at Sandhurst, the elite military academy, and their counterparts at the working-class Marine School. The dismal working and living conditions of urban Americans during the Gilded Age were reflected in a 1- 1/2 inch decline in the average height of men born in 1890, compared with those born in 1830. Americans born after 1920 were the first industrial generation to regain preindustrial stature.

So what is America’s modern height lag telling us?

There is normally a strong association between per capita income and a country’s average height. By that standard, Americans should be taller than Europeans: U.S. per capita G.D.P. is higher than that of any other major economy. But since the middle of the 20th century, something has caused Americans to grow richer without growing significantly taller.

It’s not the population’s changing ethnic mix due to immigration: the stagnation of American heights is clear even if you restrict the comparison to non-Hispanic, native-born whites.

And although the Komlos-Lauderdale paper suggests that growing income and social inequality in America might be one culprit, the remarkable thing is that, as the authors themselves point out, even high-status Americans are falling short: “rich Americans are shorter than rich Western Europeans and poor white Americans are shorter than poor Western Europeans.”

We seem to be left with two main possible explanations of the height gap.

One is that America really has turned into “Fast Food Nation.”

“U.S. children,” write Mr. Komlos and Mr. Lauderdale, “consume more meals prepared outside the home, more fast food rich in fat, high in energy density and low in essential micronutrients, than do European children.” Our reliance on fast food, in turn, may reflect lack of family time because we work too much: U.S. G.D.P. per capita is high partly because employed Americans work many more hours than their European counterparts.

A broader explanation would be that contemporary America is a society that, in a variety of ways, doesn’t take very good care of its children. Recently, Unicef issued a report comparing a number of measures of child well-being in 21 rich countries, including health and safety, family and peer relationships and such things as whether children eat fruit and are physically active. The report put the Netherlands at the top; sure enough, the Dutch are now the world’s tallest people, almost 3 inches taller, on average, than non-Hispanic American whites. The U.S. ended up in 20th place, below Poland, Portugal and Hungary, but ahead of Britain.

Whatever the full explanation for America’s stature deficit, our relative shortness, like our low life expectancy, suggests that something is amiss with our way of life. A critical European might say that America is a land of harried parents and neglected children, of expensive health care that misses those who need it most, a society that for all its wealth somehow manages to be nasty, brutish — and short.