PNHP

Need stitches on that gash? Try living without health insurance

Need stitches on that gash? Try living without health insurance

By Jamie Smith. Jamie Smith lives in Pearl River, N.Y

March 11, 2003
Chicago Tribune

I don’t have health insurance.

Unlike many of the 40 million Americans without health insurance, I could get coverage fairly easily. I am a speech pathologist by training, and it would not be hard for me to get a job with health benefits. But I have three small children, and when the oldest was a baby I decided to do what it took to stay home. What it takes is living without good health insurance.

We live, the five of us, on my husband’s modest income. We live simply, in a small apartment. We have no car and we eat a lot of lentils. Mostly, we prefer it that way. I like lentils. The problem is health care.

We practice preventive medicine as far as possible. I breastfeed; I childproof; I serve my family nutritious food; I am a hand-washing fanatic. But breastfed babies can still get ear infections. Toddlers can split their heads open on a worrisome array of innocuous-looking objects. And 4-year-olds can still get pneumonia, vitamin C and hand-washing notwithstanding.

We have almost always had some sort of coverage–cheap policies with high deductibles from companies you never heard of. But we have never gotten a dollar back from one of these policies. We buy them just in case–just in case somebody gets cancer, or falls out of a window, or gets hit by an uninsured driver. When we received the notice that the premium for our last policy was rising by 35 percent, I went rampaging around my apartment. “I could have stood on the roof and flung the money into the wind for all the good this policy has done me, and now they want more money for the useless thing?” And then I paid the bill.

Just in case.

I follow the newspaper coverage of the health-care crisis. The articles are all too familiar. “Doctors raise charges for patients without insurance,” the paper tells me, as I observe grimly that I have been charged $140 for a 10-minute well-child exam. An insurance company has the clout to announce that it will pay only a third of that amount; the uninsured patient who tries that strategy will quickly find himself in the hands of a collection agency.

“Premiums rising,” the headlines say. Don’t I know it.

I used to think that was just the way things were–until we moved to Scotland for two years. While the National Health Service has many flaws, it was a revelation to see how well universal coverage could work. When my oldest son fell and needed stitches, I took him to our local children’s hospital. We were treated promptly and professionally; he has a tiny white scar and pleasant memories of the hospital. We chose to have our second child while we were living there, and I was struck again and again by the wisdom of the British system of perinatal care: cheaper, safer, smarter, accessible to any pregnant woman regardless of the vagaries of her employer’s benefits plan.

When we returned to the U.S. I found myself questioning the third-party payer system. Why do we pay so much money to insurers, who make a profit based on how little of it is passed along to the people who provide the services?

What if we cut out the middleman? Why have for-profit entities been afforded so much decision-making power?

Back in the U.S. my second son fell into an end table on a Saturday afternoon.

As I surveyed the gash on his forehead, I found myself wondering how much an emergency room visit would cost and how big his scar would be if we didn’t go–hating myself for making the calculation, making it anyway. A friend had been billed $1,000 to repair a comparable injury. We stayed home. With shaking hands and butterfly bandages I brought the edges of the cut together. But I am no doctor. His scar is not conspicuous but it is present. And every time I see it I feel guilty.

I know I am far from alone in my frustration. Every time health insurance comes up in conversation, more questions surface about the long-term cost of the third-party payer system. How many children lose out on having a sibling because of the cost of maternity coverage? How many people abandon the dream of owning a business because of the cost of providing health coverage for a family? How many retirement-age employees slog on at work to provide health insurance for a spouse?

In the busy pediatric clinic where I worked before my first child was born, almost all the receptionists who became pregnant returned to work after their maternity leaves. The pay was meager (especially given the cost of child care) but the benefits were good; they needed the insurance.

After his second post-doctoral research position, my husband decided to switch career directions and get off the academic track. I was relieved at the prospect of having health benefits, but I found myself with more questions.

Would it be unethical to participate in a system which is so fundamentally unjust? Would I really have the gumption to decline health benefits on ethical grounds? I didn’t need to worry; another headline intervened–“Employers cutting dependent coverage.” My husband’s company offers no benefits to dependents. I could buy insurance if I paid 15 percent of his monthly take-home pay to do so.

I declined. You can buy a lot of lentils with that amount of money. But the questions remain: Is it right to participate in a profoundly unjust system?

How many people have to demand other options before other options become available?

I’m still waiting for answers.

Your responses to my apology for the poetry spam

Although I had stated that I would limit postings on this list to health policy issues, because of the volume of responses received, I am unable to respond individually to your comments on my “weak apology” for the anti-war poetry. Thus this message.

Simply stated, my faith has been restored.

Although somewhat narrowly focused, I believe that the comment on a sign at peace demonstrations in Los Angeles, graciously forwarded to us by Anne Marie Staas Niedorf, expresses the sentiment and priorities of most of us:

SADDAM DIDN’T CLOSE MY HEALTH CLINIC

Risk segmentation is bad for your health system

Economic and Social Research Institute February 2003 Issues in Coverage Expansion Design

Coping with Risk Segmentation: Challenges and Policy Options by Elliot K. Wicks, Ph. D.

A factor that complicates almost all proposals to extend health insurance coverage is how to cope with risk segmentation in the small-group and individual insurance markets. Experience in these markets shows that if market forces are left to operate unfettered, people seeking private health insurance will be segregated into small risk pools that reflect their expected risk of incurring medical expenses and charged premiums accordingly. Premiums will vary widely across the spectrum of expected risk, and risk will not be widely shared. These are problems that generally do not plague large employers, because they are large enough to form their own risk pools and self-insure; that is, costs are sufficiently spread among higher-risk and lower-risk employees within the group. So the discussion that follows applies to health insurance for small employers and individuals buying coverage on their own.

Risk segmentation and the consequent wide variation in premiums create at least two kinds of problems. First, some high-risk people are not able to afford coverage. Second, the wide premium spread requires some people to pay much more than others for identical coverage, which many would consider inequitable.

Alternative Ways to Deal with Risk Selection

Prevent Risk Selection

Approach 1: Require insurers, in setting premiums, to community rate everyone.

Approach 2: Require everyone in some subset of the population who purchases coverage to buy from a common source and have each insurer base premiums on the experience of all its enrollees in the pool – for example, require all small employers to buy from a purchasing cooperative or insurance exchange.

Approach 3: Instead of charging people premiums, use public financing, as with the Medicaid and Medicare systems.

Approach 4: Single payer without health plans that accept any risk.

A single-payer system that did not put health plans at risk – as with fee-for-service Medicare – would solve both sides of the risk segmentation problem. Enrollees would not pay premiums, and thus there would be no difference in cost associated with risk differences. And insurers would not bear risk – they would just administer the system – and thus there would be no reason to compensate them for differences in the risk of the people they enroll. There would be no risk segmentation because there would be only one insurer – government.

Allow but Offset Risk Selection

Approach 1: Allow wide (though perhaps not unlimited) variation of premium based on price, but provide subsidies to help high-risk enrollees pay the high price they will face.

Approach 2: Make risk selection unprofitable by having a very good risk-adjustment process.

http://www.esresearch.org/newsletter/february03/risk_segmentation.pdf

Comment: This report describes the policy implications of various approaches to segmenting risk. It is worthwhile reading this nine page report because you will understand the problems that arise with each approach. Understanding risk segmentation makes it clear why it is so difficult, or, actually impossible, to ensure that everyone has equitable, affordable health care coverage. But the exception is the single payer approach which is unique because there would be no risk segmentation since there would be only one insurer – the government.

Why do we waste so much effort and expense on playing the risk segmentation game, perpetuating inevitable inequities, when we can save time and money and establish equity by dumping the health plans and establishing a single payer system? Do we have an aversion to logical solutions?

Our health care system is a real pill

Posted on Thu, Jan. 23, 2003

By Molly Ivins Creators Syndicate

Bet you if I had a nickel for every time someone has started an article or a speech in the past five years by saying, “The nation’s health care system is facing a crisis,” or, “Our health care system is falling apart,” I would be a rich woman today.

I suppose I could come up with some dramatic metaphor for the crumbling, tottering, greed-rotted structure, but hey, why don’t you check out your health insurance premiums and see how you’re doing? Up by 12 percent, 22 percent, 40 percent?

Larger premiums, higher deductibles, increased payments for prescription drugs? Employer dropping your coverage? Are we having fun yet?

Our money-corrupted political system isn’t about to address the systemic problems. I think it’s almost self-evident that a single-payer system is the best answer to all the problems, but since we have to deal with political reality, let’s shelve that plan for now.

The last time anyone tried to do anything about the whole system — Hillary Clinton with a not-very-good plan back in ’93 — she was shouted down by $10 million in insurance company ads, still the record for the most money spent ever to defeat a single bill.

Now we’ve got 41.2 million Americans with no health insurance — 14.6 percent of us — which ends up costing us more than it would to pay for their insurance. We pay the world’s highest health care taxes. Our government spends $2,604 per capita, the highest of any nation, including those with national health insurance, even though only a quarter of our population is covered by government insurance.

We spend 13 percent of our GDP on health care, the highest in the world. The average in the European Union and in other developed countries is 8 percent. According to the Organization for Economic Cooperation and Development, we spend a total of $4,600 per capita for health care, more than twice the average of other countries.

We ain’t getting much bang for our buck, either. Forget the “we have the finest health care in the world” claims. In both life expectancy and infant mortality, we’re below the median for developed countries.

If you stand back and look at the fiscal crisis in the states and cities, you will see that almost all of it is driven by health care costs. Naturally, the strapped states and cities can’t think of anything to do except start knocking people off Medicaid and the Children’s Health Insurance Program (CHIP). That just means they wait and get sicker before they finally end up in the emergency rooms, costing us all more money in the long run.

Sometimes the sheer stupidity of our choices is amazing.

One chunk of this insanely complicated system that the politicians are now preparing to tackle is medical malpractice costs. “Med-mal,” as it is known in the trade, is currently the subject of a particularly fruitless hissing match between Republicans and Democrats over whether the trial lawyers or the insurance companies are to blame for astronomical increases in premiums. This is complicated by the fact that trial lawyers give money to Democrats and insurance companies give money to Republicans.

We’ve all heard of ridiculous lawsuits by trial lawyers looking for a buck. The insurance companies have well-funded campaigns to publicize idiotic suits — they do not publicize it when the suits get thrown out of court. Of course, we’ve all heard of ridiculous medical mistakes as well.

It has never been clear to me why the American Medical Association goes along with blaming trial lawyers rather than insurance companies when their malpractice rates skyrocket. The fact is that malpractice is committed by a tiny percentage of doctors — 5 percent, according to Public Citizen — and the AMA could save itself and everyone else a lot of trouble by getting rid of them.

In Texas, we’ve had zero doctor’s licenses revoked because of medical errors since 1997, despite 6,038 medical malpractice claims reported to the state, including 150 times that surgeons operated on the wrong part of the body.

Of course, trial lawyers do drive at least a part of med-mal costs, but if you examine the competing claims (under the Bush administration, you have to be wary of government data because it increasingly uses only insurance industry figures), the insurance industry is the primary villain. (If this were a lawsuit, the trial lawyers would figure out how much blame to assign to each of the parties to the last decimal point.)

According to The Wall Street Journal, the insurance industry folks are jacking up prices not just because their investments in the stock market have fallen dramatically but also because they fouled up their pricing practices in the early ’90s. They seriously underpriced med-mal and are now trying to recoup, and for this they blame the trial lawyers.

California is an interesting case in point. The state passed a tort reform bill, limiting what one can recover in a lawsuit, in 1975 and waited expectantly for insurance premiums to go down. They nearly tripled in the next 12 years, finally leveling off in the early ’90s. And, amazingly enough, California just happened to have passed strict insurance regulations in 1988.

Molly Ivins writes for Creators Syndicate. 5777 W. Century Blvd., Suite 700, Los Angeles, CA 90045

The consequences of medical debt

The Access Project, with other organizations February, 2003

The Consequences of Medical Debt

Summary of key findings:

* Having health insurance does not always protect individuals from out-of-pocket medical bills they cannot afford to pay. In our survey of low-income individuals in three communities, respondents with and without insurance were struggling with comparable levels of medical debt.

* Confusing and multiple bills, and the challenge of understanding what is owed and to whom, add to the problem.

* Provider practices – requiring cash payment upfront, flatly refusing care or suggesting people use other sources of care – made it harder for many respondents with medical debt to access care with any regularity. Patients often responded to these practices by not seeking care or filling prescriptions, or otherwise not complying with treatment regimens.

* Health care providers seem to be adopting more aggressive collection procedures, including turning over their accounts to collection agencies 30 to 60 days after a missed payment (instead of a more customary 150 to 210 days) and encouraging patients to pay off their medical bills with credit cards, a practice that burdens patients with not only large debts, but high interest payments as well.

* Many of the individuals we interviewed wanted to pay off their debt and had tried to negotiate payment plans, but found the terms of the plan very difficult to maintain given limited incomes and apparently inflexible hospital collection practices.

* Few respondents, in spite of very low incomes, were able to secure public assistance to defray the cost of their medical care. Many turned to family and friends for help, suggesting that communities may help relieve the burden of medical debt, but also share in it.

* Like other forms of debt, medical debt can have substantial financial consequences, including serious credit problems and, in extreme cases, personal bankruptcy. However, unlike other forms of debt, medical debt is often involuntary, the result of an event over which one has little or no control.

* Bankruptcy may offer a means to relief from medical debt and from the harassment of collection agencies and its attendant stress. This is particularly the case for the uninsured – people who are likely to have relatively fewer resources and be less able to make regular payments on their debt.

* Medical debt made it harder for respondents to achieve self-sufficiency; they were hindered in their ability to get a bank loan and other lines of credit, to save money, or to pay for basic goods and services.

* The effects of medical debt can be compounded if a health problem leaves a person unable to return to work. Because of the debt, people may be deterred from seeking the care needed to allow them to work. Job seeking may also be hindered by the fear of wage garnishments.

* Respondents told us that medical debt caused significant stress, anxiety and feelings of hopelessness. Medical debt can also be a source of embarrassment and shame, and many respondents were frustrated and angry that they were being financially punished for a medical event over which they had little control.

Health care is a business unlike most others. The customers are, by definition, in a vulnerable position by virtue of the medical problem for which they seek services. The providers of these services differ from sellers in most other markets because their product is essential and often life saving, and is governed by ethical responsibilities that exceed those that apply in typical commercial transactions. Purchases are often sudden and unplanned and, particularly for people without health insurance, may bring large financial burdens that are involuntary in the sense that they are not the result of a traditional consumer choice.

http://www.accessproject.org/downloads/med_consequences.pdf

Comment: Warning: this report is difficult to read. It is not a report of technical complexity. Rather it is a report that has a Dickensian quality, including the Tiny Tims whose suffering is compounded by medical debt, and the institutional and individual provider Scrooges with their passive automaticity when faced with the “need” to collect unpaid debts. The report is punctuated with quotations. If you cry easily, this may make you do so.

We are spending $1.66 trillion on health care this year. Our existing policies ensure that our administrative excesses will always be fully funded for the benefit of the insurers. But our policies are not designed to prevent medical debt for vulnerable patients. Yet only a very small portion of funds directed to the wasteful administrative excesses would be more than adequate to cover all medical debt. It is so tragic and so needless.

Let’s change our policies. Let’s reduce the waste by changing to an administratively efficient, public insurance program, and use the savings to provide everyone comprehensive coverage. Medical debt then could be relegated to the Dickensian novels where it belongs.

What is California HealthCare Foundation's true mission?

What is California HealthCare Foundation’s true mission?
By Don McCanne

Following is a description of the California HealthCare Foundation from their own website:

“The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving California’s health care delivery and financing systems. Formed in 1996, our goal is to ensure that all Californians have access to affordable, quality health care.

“CHCF’s work focuses on informing health policy decisions, advancing efficient business practices, improving the quality and efficiency of care delivery, and promoting informed health care and coverage decisions.

“CHCF commissions research and analysis, publishes and disseminates information, convenes stakeholders, and funds development of programs and models aimed at improving the health care delivery and financing systems.”

And California HealthCare Foundation’s stated mission:

“Mission statement: to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of the people of California.”

Understanding the origin of California HealthCare Foundation (CHCF) is important. During the decades that Blue Cross of California was a non-profit entity, it received favorable tax treatment not available to for-profit insurers. When Blue Cross of California converted to a for-profit entity, becoming a subsidiary of WellPoint, it was decided that the accrued value of the tax subsidy should not be granted gratis to the new shareholders of WellPoint, but should utilized for the benefit of Californians since this vested interest rightfully belonged to them. It was decided that this could be accomplished by establishing the California HealthCare Foundation and the California Endowment. The funds would then be used to improve the health care system in California, benefiting the underserved, and, in fact, benefiting all Californians by “improving the delivery and financing systems.”

Mark D. Smith, MD, MPH, President and Chief Executive Officer of California HealthCare Foundation, has infused foundation funds into research and reports on health plans, managed care, insurance markets, MediCal and other aspects of our current system. But he has often expressed his view that a single, universal health insurance program is not an option for reform. In spite of the California Health Care Options Project study that demonstrated that single payer reform could provide affordable, comprehensive coverage for all Californians (a goal of CHCF), he seems to continue to exclude that option from CHCF activities.

Yesterday we saw an interesting example of this apparent bias. The Kaiser Daily Health Policy Report sends out summaries of important policy issues, published by The Advisory Board Company. One item yesterday included reference to a New York Times article on employers’ concerns about health care costs, along with reference to the USA Today editorial debate on two views of controlling health care costs. It ended with my comment that we need to throw out the wasteful, ineffective health plans and spend the money on patients instead.

The items of national interest are often repeated in their entirety in California Healthline, a similar publication of the California HealthCare foundation, also published by The Advisory Board Company. The article above was no exception except for one remarkable difference. The New York Times segment was carried, but the USA Today segment on controlling costs by replacing health plans with a public program was deleted and another USA Today story on reducing costs by exercising and eating well was substituted. Is it not unreasonable to ask what happened? Why was a statement highly unfavorable for health insurers such as Blue Cross deleted?

The health care crisis in California, and, indeed, in the nation has reached proportions such that reform is mandated. This is the time to be examining all options for reform. An informed state and national discourse are essential. The California HealthCare Foundation should be front and center as a resource on policy issues. And since they are utilizing funds that originated from California taxpayers, they have an ethical obligation to be certain that their process is as open and unbiased as possible.

It is reasonable to ask a few questions.

* Does Blue Cross/WellPoint still exert any control over this process that has deliberately excluded options that would remove Blue Cross as a player in the health care system?

* Do members of the board of directors have any conflicts of interest that might cause them to fail in their ethical obligation to support the interests of Californians and their health care system?

* Does Mark Smith have either an ideological bias, or a vested interest in California health plans, especially Blue Cross, that might disqualify him from administering ethically the California HealthCare Foundation in the interests of all Californians?

* Why did The Advisory Board Company take the unusual step of changing a portion of this one article for publication in California Healthline?

* What is California HealthCare Foundation’s true mission?

These and other questions I believe are quite reasonable. I don’t have the answers. Perhaps those in the media receiving this message may want to try to discover the answers. If you have friends interested in investigative reporting, you may want to forward this message to them.

The rest of us must intensify our efforts to demand fairness and openness in the process. We must be sure that the reform we end up with will be in the best interests of all patients.

About CHCF: http://www.chcf.org/aboutchcf/

Kaiser Daily Health Policy Report on the New York Times article on employers’ health care costs, and on the USA Today debate on managing costs (requires registration): http://www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=16431&dr_c at=3

California Healthline on the New York Times article on employers’ health care costs, and on a substitute USA Today article on reducing costs by exercising and eating well (requires registration, and limited to California residents): http://www.californiahealthline.org/members/basecontent.asp?contentid=48118& collectionid=3&contentarea=23810

What is California HealthCare Foundation’s true mission?

What is California HealthCare Foundation’s true mission?
By Don McCanne

Following is a description of the California HealthCare Foundation from their own website:

“The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving California’s health care delivery and financing systems. Formed in 1996, our goal is to ensure that all Californians have access to affordable, quality health care.

“CHCF’s work focuses on informing health policy decisions, advancing efficient business practices, improving the quality and efficiency of care delivery, and promoting informed health care and coverage decisions.

“CHCF commissions research and analysis, publishes and disseminates information, convenes stakeholders, and funds development of programs and models aimed at improving the health care delivery and financing systems.”

And California HealthCare Foundation’s stated mission:

“Mission statement: to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of the people of California.”

Understanding the origin of California HealthCare Foundation (CHCF) is important. During the decades that Blue Cross of California was a non-profit entity, it received favorable tax treatment not available to for-profit insurers. When Blue Cross of California converted to a for-profit entity, becoming a subsidiary of WellPoint, it was decided that the accrued value of the tax subsidy should not be granted gratis to the new shareholders of WellPoint, but should utilized for the benefit of Californians since this vested interest rightfully belonged to them. It was decided that this could be accomplished by establishing the California HealthCare Foundation and the California Endowment. The funds would then be used to improve the health care system in California, benefiting the underserved, and, in fact, benefiting all Californians by “improving the delivery and financing systems.”

Mark D. Smith, MD, MPH, President and Chief Executive Officer of California HealthCare Foundation, has infused foundation funds into research and reports on health plans, managed care, insurance markets, MediCal and other aspects of our current system. But he has often expressed his view that a single, universal health insurance program is not an option for reform. In spite of the California Health Care Options Project study that demonstrated that single payer reform could provide affordable, comprehensive coverage for all Californians (a goal of CHCF), he seems to continue to exclude that option from CHCF activities.

Yesterday we saw an interesting example of this apparent bias. The Kaiser Daily Health Policy Report sends out summaries of important policy issues, published by The Advisory Board Company. One item yesterday included reference to a New York Times article on employers’ concerns about health care costs, along with reference to the USA Today editorial debate on two views of controlling health care costs. It ended with my comment that we need to throw out the wasteful, ineffective health plans and spend the money on patients instead.

The items of national interest are often repeated in their entirety in California Healthline, a similar publication of the California HealthCare foundation, also published by The Advisory Board Company. The article above was no exception except for one remarkable difference. The New York Times segment was carried, but the USA Today segment on controlling costs by replacing health plans with a public program was deleted and another USA Today story on reducing costs by exercising and eating well was substituted. Is it not unreasonable to ask what happened? Why was a statement highly unfavorable for health insurers such as Blue Cross deleted?

The health care crisis in California, and, indeed, in the nation has reached proportions such that reform is mandated. This is the time to be examining all options for reform. An informed state and national discourse are essential. The California HealthCare Foundation should be front and center as a resource on policy issues. And since they are utilizing funds that originated from California taxpayers, they have an ethical obligation to be certain that their process is as open and unbiased as possible.

It is reasonable to ask a few questions.

* Does Blue Cross/WellPoint still exert any control over this process that has deliberately excluded options that would remove Blue Cross as a player in the health care system?

* Do members of the board of directors have any conflicts of interest that might cause them to fail in their ethical obligation to support the interests of Californians and their health care system?

* Does Mark Smith have either an ideological bias, or a vested interest in California health plans, especially Blue Cross, that might disqualify him from administering ethically the California HealthCare Foundation in the interests of all Californians?

* Why did The Advisory Board Company take the unusual step of changing a portion of this one article for publication in California Healthline?

* What is California HealthCare Foundation’s true mission?

These and other questions I believe are quite reasonable. I don’t have the answers. Perhaps those in the media receiving this message may want to try to discover the answers. If you have friends interested in investigative reporting, you may want to forward this message to them.

The rest of us must intensify our efforts to demand fairness and openness in the process. We must be sure that the reform we end up with will be in the best interests of all patients.

About CHCF: http://www.chcf.org/aboutchcf/

Kaiser Daily Health Policy Report on the New York Times article on employers’ health care costs, and on the USA Today debate on managing costs (requires registration): http://www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=16431&dr_c at=3

California Healthline on the New York Times article on employers’ health care costs, and on a substitute USA Today article on reducing costs by exercising and eating well (requires registration, and limited to California residents): http://www.californiahealthline.org/members/basecontent.asp?contentid=48118& collectionid=3&contentarea=23810

Cost control that fixes our system

USA TODAY
3/6/2003
Editorial/Opinion

USA TODAY’s view:

Affordable remedies ignored as nation’s health woes soar

Perhaps the best measure of the depth of the nation’s health care troubles is this: Amid terror warnings, possible war with Iraq, a faltering stock market and a sluggish economy, a new poll says the public’s top worry is rising health care costs.

Some achievable steps:

* Lowering drug costs. * Cutting hospital bills. * Providing affordable insurance. * Helping consumers cut costs.

None of these cost-saving ideas alone will solve the nation’s health care problems. But bipartisan cooperation to enact them could prime the pump for more comprehensive reforms, improve the competitiveness of the health care marketplace and make consumers more aware of medical costs.

The country’s rising concerns about a broken health care system can’t be ignored indefinitely. Small repairs today can pave a path for bigger solutions tomorrow.

For the full USA TODAY editorial: http://www.usatoday.com/news/opinion/editorials/2003-03-05-our-view_x.htm

Opposing view:

Nationalize health care By Don McCanne

The continuing rise in health care costs is proof that our existing system of competing health plans has been incapable of controlling costs. Decades of attempts to improve coverage through a hodgepodge of private plans and public programs have resulted only in higher costs and greater numbers of uninsured. Current proposals that build on our existing system promise only higher costs and the perpetuation of the profound administrative waste that is unique in the world. We spend more on paperwork in our health care system than we do for our entire military budget – almost $400 billion.

Single-payer national health insurance, by contrast, would slow the growth of health-care costs well into the future. And it would ensure that everyone has access to comprehensive health care services.

What do we really want out of our health care system?

* We want affordability. Placing our health care system on a single budget would provide a mechanism to finally corral health care costs for all of us.

* We want our health-insurance dollars to be spent on patients, rather than private-health-plan bureaucracies. By eliminating administrative waste caused by the health plans and the costly burden they place on the system, we would free up more than enough to pay for coverage of the uninsured and truly comprehensive benefits for all.

* We want our health insurance always to be there. With a universal insurance program, we would never lose coverage because of a change in employment, early retirement or a financial setback that makes premiums unaffordable.

* We want to be free to choose our physicians and hospitals instead of being penalized for failing to use the provider chosen by the insurance company.

* We want to have access to care whenever we need it rather than when and where the insurance company dictates.

The marketplace will not serve us well in health care if we depend on health plans. They would continue to compete based on the price of their premiums. But with rising costs, plans can keep their premiums competitive only by shifting costs to patients in the form of fewer benefits and greater out-of-pocket payments. This would threaten the financial security of those with the greatest health care needs.

On the other hand, competition based on quality would be beneficial. Since we would have free choice of doctors and hospitals, the providers themselves would be motivated to compete for patients based on the quality of their services.

A single-payer system, funded at our current level of spending, would provide high-quality, comprehensive, affordable health care for everyone. But we can achieve this only if we throw out the wasteful, ineffective middlemen – the health plans – and spend the money on patients instead.

Don McCanne, M.D., is president of Physicians for a National Health Program.

http://www.usatoday.com/news/opinion/editorials/2003-03-05-oppose_x.htm

Wisconsin Joins State-Led Single-Payer National Health Program Movement with Universal Health Care Bill

Contact: Art Taggart Coalition for Wisconsin Health phone: 608-833-8888 mobile: 608-217-9650 email: ataggart@facstaff.wisc.edu

Representative Mark Miller and Congresswoman Tammy Baldwin Team with The Coalition for Wisconsin Health to Introduce Universal Health Plan Bill

MADISON, WI, March 6, 2003 ā€” Representative Mark Miller and Congresswoman Tammy Baldwin will join members of the Wisconsin Coalition for Health to introduce The Wisconsin Universal Health Plan bill at a press conference in the State Capitol Assembly Parlor on March 10, at 10am. State Senator Tim Carpenter will also be in attendance to introduce a companion bill proposing a single-payer health care program.

“Wisconsin’s superior health care is at risk because double digit increases in health insurance premiums combined with economic uncertainty makes it increasingly difficult for employers to maintain their commitment to providing health insurance for their employees,” states Mark Miller. “A single-payer system, as proposed in this bill, should allow expansion to all residents of the state and greater efficiency for providers.”

The Wisconsin Universal Health Plan bill is co-sponsored by The Coalition for Wisconsin Health, a collection of more than 60 organizations from farm, labor, disability, faith-based, and senior organizations dedicated to providing health care as a fundamental right. The aim of the group is to provide comprehensive health care for every Wisconsin resident regardless of race, ethnicity, color, creed or economic standing.

“Insurance companies continue to ask government to provide coverage for those most in need of health care, while they use underwriting principles to skim the healthiest for their risk pools,” explains Art Taggart, of the Coalition for Wisconsin Health. “If you are very healthy, insurance companies want your business; if you are very disabled, taxpayers provide your coverage. It is the working poor and those with pre-existing conditions who are left out in the cold.” [more]

Speakers at the press conference will include:

-Representative Mark Miller, State (D), Assembly District 48 -Representative Tammy Baldwin (D), 2nd Congressional District -Senator Tim Carpenter (D), 3rd Congressional District -Art Taggart, Coalition for Wisconsin Health; Epilepsy Foundation South Central WI -Dr Franklin Stein, Professor Emeritus, University of South Dakota Medical School; Founding Editor, Occupational Therapy International -Dr. Linda Farley, Physicians for a National Health Program -James T. Wrich, Analyst, Health Systems Performance Co.

Dr. Linda Farley will represent concerned physicians on Monday: “Health Care is a service, not a commodity,” Farley said. “Physicians must be committed to providing quality care to all the people based on their need, not on their ability to pay. The Wisconsin Universal Health Care bill would allow physicians and other health care workers to concentrate on the health of patients and populations, without the hassles of excessive paper work.”

Select Features of The Wisconsin Universal Health Plan Bill

The Wisconsin Universal Health Plan is a comprehensive plan to provide quality health care to all Wisconsin residents-rich, and poor, young and old, regardless of health condition, medical history or employment status. By replacing over 700 different health insurers with a single publicly financed plan, it would eliminate waste and red tape. It would be administered at the state and local level, accountable to the residents of Wisconsin.

Administration: A single-payer, publicly funded program administered by the Department of Health, Planning and Finance under the guidance of the Wisconsin Health Policy Board

Coverage: Covers all Wisconsin residents regardless of pre-existing health condition, age, sex, race, sexual orientation, geographic location, employment or economic status.

Covered services: Hospital and clinic services; office visits and house calls; Services of physicians, dentists, social workers, and other licensed professionals; Prescription drugs; Health promotion and illness or injury prevention; Long term care, including home and nursing home care, and community health centers; Mental health services, and alcohol and other drug rehabilitation services

Freedom of Choice: Freedom for patients to choose health providers.

Quality and oversight: Sets up monitoring and oversight mechanisms in six regions of the state. Regional investigations of quality, access to medical services, and consumer complaints

Financing: Establishes Health Trust Fund in Department of Health Planning and Finance. All revenues earmarked for health care to be deposited into Fund, from which all providers are reimbursed.

Insurance Industry role: Health insurance coverage permitted for services not covered by WUHP.

Physicians for a National Health Program (PNHP) is a research and education organization with more than 10,000 members representing every state and specialty. PNHP was founded in 1987 and has physician spokespeople across the country. For contact information, call the national headquarters in Chicago at (312) 782-6006. Visit us online at www.pnhp.org. To interview a member of PNHP about the ever-growing national single-payer movement, contact Ida Hellander at 312.782.6006 or pnhp@aol.com

Also read today’s USA TODAY op-ed by PNHP President Don Mccanne:

http://www.usatoday.com/news/opinion/editorials/2003-03-05-oppose_x.htm

Why does Aetna need racial and ethnic data?

The Washington Post
March 5, 2003
The Associated Press
Report: Aetna Collecting Minority Data

Aetna Inc. has begun collecting data on the racial and ethnic backgrounds of some of its 14 million health plan members in what the insurer calls an effort to narrow the gaps in treatment between whites and minority patients, The Wall Street Journal reported.

Aetna said it is trying to understand differences in how white and minority patients get medical care, and to develop prevention, education and treatment programs to narrow the gap. But critics say collecting the data raises questions about patient privacy and racial profiling.

One concern is that insurance companies could use such information for underwriting decisions and “make it difficult for the people who need coverage to get coverage,” said Clyde Yancy, a cardiologist at the University of Texas Southwestern Medical Center in Dallas, who has studied racial disparities.

The Hartford, Conn.-based company rolled out the initiative in 13 states and the District of Columbia in September, asking new members or those changing health plans or beneficiaries to voluntarily list their race or ethnic status on the application.

“There is a disparity under every rock and a disparity behind every tree,” Aetna chairman and chief executive John W. Rowe told the paper in a story on its Web site. “We need to do something about it.”

http://www.washingtonpost.com/wp-dyn/articles/A43387-2003Mar5.html

Comment: It is very difficult to see what clinical use Aetna would make with racial and ethnic data collected during the enrollment or underwriting process. Clinical interventions, such as disease management programs usually are initiated by identifying clinical problems through the claims process instead. Since responses are voluntary, this is a population sampling process and not a process designed for individual intervention.

It is unlikely that this information would be used for underwriting in the individual market. Although risk does vary with ethnicity and race, could you imagine Aetna sending a notice of higher premiums or even rejection because you’re black? Although Aetna’s business practices have often been insensitive to needs of patients, they’re not dumb enough to institute a program that could provoke a boycott.

But this information could have important business value for Aetna in their group health plan markets. A significant sampling of race and ethnicity could indicate to them that there is risk of greater medical losses. Thus they could tailor the premiums, benefits and cost sharing to assure profitability in these “unfavorable” markets. This is a policy that assures that those with the greatest health care needs will also have the greatest financial exposure.

Although the insurance industry consumes an outrageous amount of our health care dollars, they are not providing a service but rather a disservice by compounding the inequities and injustices of our system. Why do we continue with policies that reward this amoral and even immoral industry? If we had our own single, universal, public program, we could assure that the appropriate extra resources required by groups that suffer from disparities would be directed to their needs.

But, instead, it looks like we’ll continue to build on our current system that assures that John Rowe will continue to build his mega-wealth.

Sick! Sick!

Bush proposal to modernize and defund Medicare

The White House
March 4, 2003
President to Announce Framework to Modernize and Improve Medicare

Excerpt from the Executive Summary:

Option 1-Traditional Medicare

Those who are satisfied with the current Medicare system will continue receiving their care as they do today with help for the high costs of prescription drugs. These beneficiaries will gain access to discounted drugs through a prescription drug discount card-estimated to achieve savings of 10-25% on the cost of prescription drugs-as well as coverage to protect them against high out-of-pocket prescription drug expenses. These new benefits will be provided at no additional premium.

Option 2-Enhanced Medicare

Enhanced Medicare will give seniors the same types of choices that are available to members of Congress and other federal employees. In every area of the country, Medicare beneficiaries will have multiple health plans from which to choose. These plans will offer prescription drug benefits, full coverage of preventive benefits, protection against high out-of-pocket drug costs, and cost sharing that does not penalize participants who need the most medical care. Again, the decision to choose Enhanced Medicare will be entirely up to each senior, and participants will be able to choose any doctor or any hospital they want for the treatment and care they need.

The President’s framework will ensure that the benefits offered under Enhanced Medicare are sufficiently attractive to seniors, relative to traditional Medicare, to guarantee that Enhanced Medicare is a viable system.

Option 3-Medicare Advantage

Seniors will also have the option of enrolling in low-cost and high-coverage managed care plans, similar to those available today under Medicare. Medicare Advantage will include plans that offer a subsidized drug benefit, and all plans will be able to offer extra benefits, as many private plans do today.

Excerpt from the Conclusion:

To improve, Medicare must have the benefit of modern health care delivery systems and methods that have proven successful in the private sector. The President’s initiative will introduce private sector innovation and competition to the Medicare system to help keep costs reasonable, ensure high quality care and begin to address Medicare’s long-term financial challenges.

While Medicare must be modernized and improved to meet the needs of its current participants, the program must also be made sustainable for future generations. Given the financial challenges Medicare faces in the future, changes to the Medicare program we make today must not exceed our nation’s means to deliver them tomorrow.

http://www.whitehouse.gov/news/releases/2003/03/20030304-1.html

Comment: To understand the administration’s proposal, we must keep in mind what this program to “modernize” Medicare is intended to accomplish. Regardless of all of the rest of the rhetoric, the sole intent is to reduce the federal (taxpayer) contribution to the health care of the Medicare beneficiaries. Period. All of the wonderful, free-market rhetoric is designed to distract us from this precise goal. With that in mind, let’s look at the three options offered (though not in order).

Option 1 – Traditional Medicare: The traditional Medicare program is inadequate. The lack of pharmaceutical coverage is a glaring example. The traditional Medicare program needs more funds, precisely what the administration is avoiding. So we will see no recommendations for an expansion of benefits in the traditional program.

But to meet campaign promises, they propose introducing a worthless discount prescription card, and they propose to provide the wealthy with protection for high drug costs by providing coverage only after spending many thousands of dollars on drugs. For very low income individuals, they’ll cover up to $600 worth of drugs. It is uncertain if this paltry coverage reflects the value that they assign to the unfortunate individuals in this sector of society.

A second reason that they do not want to add more benefits to the traditional program is that want to use those benefits to lure beneficiaries out of the traditional program and into private plans.

Option 3 – Medicare Advantage: This is the current Medicare + Choice program. It was a failure. It worked only as long as the plans could limit their exposure to high costs by selectively marketing to a healthy sector. But the plans failed to provide the administrative efficiencies promised, and ended up costing the government more, on a risk adjusted analysis. The only way that it could be salvaged is to increase taxpayer funding beyond that of the traditional program, again the opposite of the administration’s goal. They’ve decided to let this program fade away.

Option 2 – Enhanced Medicare: As promised, this is the proposal similar in design to the Federal Employees Health Benefit Plan, “the plan that the members of Congress have.” This is basically the Breaux-Frist-Thomas-Jindal premium support proposal. It is a defined contribution concept, though some defenders dispute the terminology.

An important sentence in the White House release: “Beneficiaries who enroll in an average priced plan in their region would pay a premium for the medical portion of their coverage equal to the Part B premium.” Clearly this confirms that individuals who desire more comprehensive benefits, or who wish to reduce their financial exposure, will have to bear the costs of that additional coverage in the form of higher premiums. So the wealthy are well cared for in this proposal.

What about those individuals who do not have the resources to purchase more comprehensive coverage? What will their program offer? A clue: “To provide an array of choices in benefit design and to encourage plan innovation, plans will be free to structure their offerings differently, provided the benefit meets a basic federal standard. “Plan innovation with flexibility in offerings” should make us worry. Spartan plans will surely become the “averaged priced” plans. And we can only speculate that an administration that doesn’t have any money for anything else, certainly will not have enough money to fund more than the very lowest tier of services that is the “basic federal standard.”

Then the politicians will ask why we should be spending more on traditional Medicare patients than we do on the “basic federal standard.” And of course their solution will be to cut funding of the traditional program.

This scheme does not reduce the costs of health care; it merely shifts the costs from the federal government to the Medicare beneficiary. The majority will be unable to afford their portion of costs should they be faced with a major medical disorder.

Should Medicare policy be crafted to improve the utilization of resources for the benefit of patients, or should it be designed simply to reduce federal funding of the program? It looks like the Bush administration has decided that Medicare should be added to list of programs to be sent off to the guillotine for a blunt trimming.

California Single-Payer Bill Introduced

For Immediate Release Contact: Beth Capell

California Physicians Alliance Supports SB921 (Kuehl)

Health Care for Every Californian

Today, James G. Kahn, M.D., M.P.H., author of one of the nine Health Care Option Papers, and treasurer of the California Physicians Alliance joined Senator Sheila Kuehl (D-Santa Monica), other legislators and representatives of other organizations in announcing their support for SB921 by Senator Kuehl.

“In a time of skyrocketing health care costs when millions of Californians lack health coverage, SB921 would cuts costs by reducing administrative waste and refocusing health spending on health care, not overhead,” said Jim Kahn.

SB921 would provide health coverage to every Californian—every Californian would have the health care they need when they need it—whether their employer offered health coverage or not, whether they were between jobs or not, whether they were a young person just starting out, or somebody in their 50’s forced into early retirement.

SB921 creates a system of public financing of health care, similar to that used for Medicare. An independent analysis of the research by Kahn et al demonstrated that employers who do the right thing and buy health insurance now would save money under this system. So would most Californians.

As for Medicare and unemployment insurance, employers would pay a tax to cover the cost of health care. Employees would also make a contribution. SB921 also includes increased taxes on alcohol and tobacco to supplement the payroll taxes and employee contributions.

SB921 takes some of the best aspects of HMO reform and applies them to the entire health system: putting the doctor in charge of health care, evaluating whether care is medically appropriate, assuring that consumers have a voice in the health care system.

The California Physicians Alliance is a non-profit, public interest group of physicians and other health activists committed to universal access to quality, affordable health care for all Californians. CaPA was instrumental in creating HMO reforms enacted in California in 1999.

The full text of the bill is available here: http://info.sen.ca.gov/pub/bill/sen/sb_0901-0950/sb_921_bill_20030221_introd
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http://info.sen.ca.gov/pub/bill/sen/sb_0901-0950/sb_921_bill_20030221_introd
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