PNHP

The Kaiser Commission on Medicaid and the Uninsured The Cost of NOT Covering the Uninsured Project

The Kaiser Commission on Medicaid and the Uninsured The Cost of NOT Covering the Uninsured Project

May 2002
“Sicker and Poorer: The Consequences of Being Uninsured” By Jack Hadley, Ph.D., Principal Research Associate, The Urban Institute

… this report focuses primarily on the relationship between health insurance and health outcomes, which has been addressed by a surprisingly large number of studies over the past 25 years, as well as the link between health and educational attainment and economic opportunity.

This review shows that there is a substantial body of research consistent with a model postulating positive relationships between health insurance, use of medical care, health, income, and education. However, as noted at the outset, none of these studies is definitive, nor are their findings universal. The literature also includes studies that have failed to find a positive relationship between good health and having health insurance or using more medical care.

While all of these studies suffer from methodological flaws of varying degrees, two general observations appear warranted. The first is the fairly remarkable degree of consistency across the studies that support the underlying conceptual model of the relationship between health insurance and health. Studies of different medical conditions, conducted at different times, using different data sets and statistical methods have produced quantitative estimates of the effects of having health insurance or using more medical care that are both consistent with each other and fall within a relatively narrow range. This degree of quantitative agreement across studies reinforces the implications of any single study taken by itself.

The second general observation, holding aside issues of potential methodological weaknesses, is that many of the studies that failed to find a positive association between health insurance or medical care use and health do not obviously generalize to the current population of uninsured nonelderly adults and their families. Casual empirical observations of pre-Medicare/Medicaid data in the U.S., studies of inefficient medical care use by the elderly or privately insured, and studies of birth outcomes may not be directly relevant to assessing the health benefits of extending health insurance to those who are currently without insurance coverage. Even if one accepts as valid the findings of the more methodologically sound studies that suggest little or no health benefit from additional medical care use by well-insured populations, it does not necessarily follow that the uninsured would not benefit both from health insurance coverage and from greater medical care use. Holding both points of view would not be inconsistent. In fact, it would seem to be both inappropriate and unfair to argue on the basis of these studies that the uninsured should be penalized, i.e., denied help in obtaining insurance coverage, because of the inefficient or excessive use of medical care by the well insured.

This report concludes that a compelling case has been made that having health insurance does lead to improved health by means of better access to medical care. Furthermore, the available research on the links between health insurance, health status, and an individual’s productivity begins to provide a reasonable basis for future economic analyses of the benefits of health insurance to the nation as a whole.

The next step for health services research is to estimate the size of the economic benefits of continuous health coverage. Estimates of the size of the potential economic benefits should become a prominent part of policy debates over expanding health insurance coverage. These estimates may help shift the current focus from the direct costs of health insurance expansions to the question of how much is likely to be saved by expanding coverage, and ultimately to policy decisions based on a truer sense of the net cost to the nation to cover all Americans.

(The comments above include excerpts from the Executive Summary and excerpts from the Full Report that have been commingled .)

http://www.kff.org/content/2002/20020510/

Comment: This comprehensive review of the extensive research on the consequences of being uninsured is a very valuable resource that confirms that the lack of insurance has major negative impacts. This report can be used to refute the arguments of those that use isolated studies to suggest that the uninsured do receive the care that they really need. They clearly do not.

Remarks by the President to Coalition for Medicare Choices

The White House
May 17, 2002

President George W. Bush:

… the myth is somehow that if seniors are given choice, low income seniors will not benefit; that if we provide more options for our senior citizens to tailor plans that meet their needs, that somehow the low income will be left behind.

Part of my message today is I want to work with you to provide more choices and more savings for our seniors. (Applause.) I’m a person who trusts people. See, I trust the American people. The American people are fantastic, great citizens. We’ve got to trust people with their own choices in life. I’d rather have the American people make choices than the federal government make choices on their behalf. (Applause.)

We need a fair system of competition. We need a system that guarantees that patient protections and all of Medicare’s required benefits are included in every choice; a system that encourages additional benefits and options for better care at lower cost, including improved medical savings accounts.

That’s what we need to think about, and that’s where we ought to head here in America. The costs savings from competitive reforms are essential. They’re essential. If you notice, and the people will testify to this, that there are lower costs in Medicare plus Choice. And those cost savings in a Medicare plus Choice plan are very important for the future, for your children and your grandchildren to be able to have a Medicare system that works.

http://www.whitehouse.gov/news/releases/2002/05/20020517-8.html

Comment:

President Bush has used “lower costs” in two contexts.

Many participants in the Medicare plus Choice plans have had lower out-of-pocket expenses and more benefits than available in the traditional Medicare program. This results in a “lower cost” for the individual Medicare plus Choice beneficiary. This has been possible because the Medicare plus Choice plans have been practicing virtuous selection by marketing their plans specifically to the healthy, thereby avoiding higher costs of chronically ill patients.

On the other hand, studies have confirmed that the Medicare plus Choice plans have higher costs per beneficiary than for comparable beneficiaries in the traditional Medicare program, primarily because of higher administrative costs. Competition of Medicare plus Choice options not only failed to reduce costs but actually failed to prevent increases in costs. This is an irrefutable fact. But when President Bush says, “The cost savings from competitive reforms are essential,” and “… a fair system of competition… a system that encourages additional benefits and options for better care at lower cost,” he is using “lower cost” in the context that the private plan options will reduce costs for the Medicare program. That is simply not true.

Since the private plans will always have higher administrative costs than the publicly administered program, the only ways to reduce costs for the program are to restrict benefits and/or to increase patient cost-sharing. Thus, President Bush’s version of Medicare modernization will allow options that provide only minimal benefits or higher out-of-pocket expenses or a combination thereof. If Medicare beneficiaries want more coverage, they will have to pay higher premiums. What will happen to low income seniors? They will have impaired access because of financial barriers erected under his proposal. And yet, President Bush states that it is a “myth… that somehow the low income will be left behind,” when given “more options to tailor plans.” The only options affordable will leave low income individuals behind.

We need to understand the problems with our health care system and the effect that various policy decisions would have on access, equity and costs. President Bush should lead the quest for the truth by dismissing his health care ideologues and bringing in serious health policy analysts that will provide an objective assessment of all options for reform. He trusts us. He trusts us with our choices. He’d rather have the American people make choices than have the federal government make choices on their behalf. He should trust us to tell him what choice we want in health care reform once we have an honest presentation of all of our potential options.

Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States

Health Affairs
May/June 2002

Surprisingly few Canadians travel to the United States for health care, despite the persistence of the myth.

by Steven J. Katz, Karen Cardiff, Marina Pascali, Morris L. Barer, and Robert G. Evans

A tip without an iceberg?

This study was undertaken to quantify the nature and extent of use by Canadians of medical services provided in the United States. It is frequently claimed, by critics of single-payer public health insurance on both sides of the border, that such use is large and that it reflects Canadian patients’ dissatisfaction with their inadequate health care system. All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. The cross- border flow of care-seeking patients appears to be very small.

Our telephone survey of likely U.S. providers of wait-listed services such as advanced imaging and eye procedures strongly suggested that very few Canadians sought care for these services south of the border. Relative to the large volume of these procedures provided to Canadians within adjacent provinces, the numbers are almost undetectable. Hospital administrative data from states bordering Canadian population centers reinforce this picture. State inpatient discharge data show that most Canadian admissions to these hospitals were unrelated to waiting time or to leading-edge-technology scenarios commonly associated with cross- border care-seeking arguments. The vast majority of services provided to Canadians were emergency or urgent care, presumably coincidental with travel to the United States for other purposes. They were clearly unrelated either to advanced technologies or to waiting times north of the border. This is consistent with the findings from our previous study in Ontario of provincial plan records of reimbursement for out-of-country use of care. Additional findings from the current study showed that a small amount of cross-border use was related to proximal services, primarily in rural or remote areas where provincial payers have made arrangements to reimburse nearby U.S. providers. Finally, information from a sample of “America’s Best Hospitals” revealed very few Canadians being seen for the magnet referral services they provide.

These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans.

Phantoms in the snow.

Despite the evidence presented in our study, the Canadian border-crossing claims will probably persist. The tension between payers and providers is real, inevitable, and permanent, and claims that serve the interests of either party will continue to be independent of the evidentiary base. Debates over health policy furnish a number of examples of these “zombies”-ideas that, on logic or evidence, are intellectually dead-that can never be laid to rest because they are useful to some powerful interests. The phantom hordes of Canadian medical refugees are likely to remain among them.

http://www.healthaffairs.org/freecontent/v21n3/s6.htm

Comment: This excellent study refutes the false generalizations that have been extrapolated from the embellished anecdotes of Canadian medical refugees in the United States. Debates on health care policy should be based on the best factual information available regardless of whether or not those facts support individual ideological viewpoints. This important study should be downloaded and made readily available to refute those that insist that single payer approaches should be dismissed immediately without further consideration merely because of the fictional massive medical migration from Canada into the United States.

Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States

Health Affairs
May/June 2002

Surprisingly few Canadians travel to the United States for health care, despite the persistence of the myth.

by Steven J. Katz, Karen Cardiff, Marina Pascali, Morris L. Barer, and Robert G. Evans

A tip without an iceberg?

This study was undertaken to quantify the nature and extent of use by Canadians of medical services provided in the United States. It is frequently claimed, by critics of single-payer public health insurance on both sides of the border, that such use is large and that it reflects Canadian patients’ dissatisfaction with their inadequate health care system. All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. The cross- border flow of care-seeking patients appears to be very small.

Our telephone survey of likely U.S. providers of wait-listed services such as advanced imaging and eye procedures strongly suggested that very few Canadians sought care for these services south of the border. Relative to the large volume of these procedures provided to Canadians within adjacent provinces, the numbers are almost undetectable. Hospital administrative data from states bordering Canadian population centers reinforce this picture. State inpatient discharge data show that most Canadian admissions to these hospitals were unrelated to waiting time or to leading-edge-technology scenarios commonly associated with cross- border care-seeking arguments. The vast majority of services provided to Canadians were emergency or urgent care, presumably coincidental with travel to the United States for other purposes. They were clearly unrelated either to advanced technologies or to waiting times north of the border. This is consistent with the findings from our previous study in Ontario of provincial plan records of reimbursement for out-of-country use of care. Additional findings from the current study showed that a small amount of cross-border use was related to proximal services, primarily in rural or remote areas where provincial payers have made arrangements to reimburse nearby U.S. providers. Finally, information from a sample of “America’s Best Hospitals” revealed very few Canadians being seen for the magnet referral services they provide.

These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans.

Phantoms in the snow.

Despite the evidence presented in our study, the Canadian border-crossing claims will probably persist. The tension between payers and providers is real, inevitable, and permanent, and claims that serve the interests of either party will continue to be independent of the evidentiary base. Debates over health policy furnish a number of examples of these “zombies”-ideas that, on logic or evidence, are intellectually dead-that can never be laid to rest because they are useful to some powerful interests. The phantom hordes of Canadian medical refugees are likely to remain among them.

http://www.healthaffairs.org/freecontent/v21n3/s6.htm

Comment: This excellent study refutes the false generalizations that have been extrapolated from the embellished anecdotes of Canadian medical refugees in the United States. Debates on health care policy should be based on the best factual information available regardless of whether or not those facts support individual ideological viewpoints. This important study should be downloaded and made readily available to refute those that insist that single payer approaches should be dismissed immediately without further consideration merely because of the fictional massive medical migration from Canada into the United States.

PBS NOW with Bill Moyers

May 17, 2002

Bill Moyers: I don’t know if your reporting has turned this up, the answer to this question, but every industrialized democracy in the West, and some developing countries, treat health care as a human right. We treat it as a function of the market. Why can’t we move toward what so many others embrace?

Julie Rovner (NPR’s health policy correspondent): I think because we’ve had this ongoing debate really over the last 50 years about which way to go. Everybody agrees that people should have health insurance, that people should be able to have access to health care, to good coverage. But we can’t resolve this, every other country managed to resolve this, most of them years ago, some of them more recently. But there is this continuing standoff, a policy standoff in Washington, to some extent in the states, too; you’ve really got people dug in on whether to get the government more out of health care or whether to get the government more into health care.

http://www.pbs.org/now/transcript/transcript_rovner.html

Comment:

Government: The act or process of governing, especially the control and administration of public policy in a political unit. (The American Heritage Dictionary of the English Language)

All nations, including the United States, utilize governments to administer health care policy. As Julie Rovner states, “Everybody agrees that people should have health insurance, that people should be able to have access to health care, to good coverage.” Since we agree on this, and we know that this goal is absolutely impossible to attain in the private sector, why aren’t we taking advantage of our ability to establish the public policy we want by utilizing our own government that belongs to all of us?

Government is not a “they,” it’s a “we.”

Opinion By AMA president

American Medical News
May 20, 2002
Richard F. Corlin, MD

“… Congress should change current rules that require physicians to participate in Medicare on an ‘all-or-nothing basis,’ regardless of our patients’ income or wealth. Physicians should have the freedom to decide, on a patient-by-patient basis, whether services are rendered under a ‘private contract’ or subject to Medicare payment limits.”

http://www.ama-assn.org/sci-pubs/amnews/amn_02/edca0520.htm

Comment: The experience in other nations has documented that parallel private and public plans result in chronic under-funding of the public program with the development of queues. Physicians then cater to the more lucrative private patients who are able to purchase their place at the front of the queue, and they neglect the patients in the public program, causing the queues to grow longer.

For over a century, conservatives have maintained a lock on the leadership of the American Medical Association. Efforts to establish objectivity in policy discussions have been repeatedly rebuffed by those in control. Perhaps this is why the AMA membership has declined from 85% to 28% in the past few decades.

The accelerating deterioration in access, coverage and costs mandates reform now. The AMA’s pious pomposity has resulted in the egregious neglect of reform that is in the interests of patients. The majority of physicians do support reform that would assure comprehensive care for everyone.

Physicians for a National Health Program is a single issue organization that advocates for a universal, comprehensive national health care program. All physicians should study the policy proposals on the PNHP website (www.pnhp.org) and the AMA website (www.ama-assn.org). It is clear that the AMA policies would compound inequities and further impair access, whereas PNHP policies would assure comprehensive services for everyone. Those physicians that really care should join PNHP and encourage their colleagues to do so as well. A strong, united voice of concerned and caring physicians can ignite the flame of reform.

For those that do care but are not yet members, go to www.pnhp.org and click on “Join PNHP.” Do it now.

Beth Capell, Ph.D., on AMA President Corlin’s comment on allowing “private contracts” for Medicare:

Great to see that the AMA still opposes Medicare after all these years!! One of the greatest boons to physician incomes as well as essential for seniors and AMA opposes it.

Actually, Corlin does not propose queuing: he proposes being allowed to ignore the low and moderate income Medicare patients entirely. That’s worse.

Beth Capell, on behalf of Health Access.

Comment: In sharp contrast to the AMA, Physicians for a National Health Program supports “Better than Medicare” for our seniors and for everyone in our nation. PNHP supports changes that would include all beneficial services, including prescription drugs, long term care, mental health services, dental, and eye care, while assuring affordability by eliminating out-of-pocket expenses. The California HCOP study and other studies confirm that this can be done without increasing overall health care costs.

Strengthen the voice of PNHP. Join today.

www.pnhp.org and click on “Join PNHP”

National Union of Public and General Employees Canada

May 15 is National Medicare Day across Canada

Ottawa – The National Union of Public and General Employees and its components will join with thousands of Canadians today on National Medicare Day, participating in a variety of nation-wide activities to demonstrate support for public medicare and to celebrate the best health care plan in the world.

May 15 has been designated National Medicare Day across the country.

NUPGE members will be marking the day by holding workplace canvasses, rallies outside hospitals and politicians’ offices and town hall meetings. They will also be distributing post cards and encircling provincial legislatures in red ribbon.

The theme of the day – A Call to Care: Patients not Profits – reflects the growing awareness that the spread of private for-profit health care threatens patients and will destroy our public medicare.

It’s been 40 years since Canada rejected for-profit health care and created no-profit medicare for everyone. The insurance companies and medical corporations still can’t believe it. They still work hard at trying to shake our faith our medicare.

They can’t. And they won’t. Not so long as we remember how it is when health care becomes a cash-and-carry, for-profit enterprise: care is expensive, inadequate and inequitable. Any hope of full care without financial ruin depends on whether or not you are covered by a private plan. Even then there are no guarantees.

When private for-profit insurance companies have to choose between their wealth and their health, we lose every time. Canadian-style medicare eliminates ever being faced with that choice.

Medicare is all ours. We made it. We like it. We want to keep it.

That’s something to celebrate.

http://www.nupge.ca/news_my02/n15my02a.htm

"Damaged Care" Premiere Features HMO Whistleblower

Contacts:
Linda Peeno MD (502) 548-7878
Steffie Woolhandler MD (617) 665-1032
Quentin Young MD (312) 782-6006

Screening on Capitol Hill to be followed by panel with Dr. Linda Peeno,
Former HMO physician who denied a heart transplant

Former Humana Medical Evaluator Dr. Linda Peeno was so disturbed by what she experienced working for the giant HMO — including denying a young patient’s heart transplant — that she went into medical ethics and is now a vocal advocate for health care reform.

A film based on the experiences of Dr. Peeno, called “Damaged Care” and including a scene showing her denying a patient’s heart transplant, will have its world premiere on Capitol Hill on Friday, May 10. Laura Dern (“Jurassic Park”) plays Dr. Peeno. Dr. Peeno testified before Congress in May of 1996 about her heart transplant case and has been outspoken about the right to health care ever since.

“As a physician working for Humana, I denied a young man a heart transplant that would have saved his life, and thus caused his death,” testified Dr. Peeno. “No person or group has held me accountable for this, because, in fact, what I did was I saved a company a half a million dollars.”

“Humana’s only concern was costs,” says Dr. Peeno. “The young man fit all the criteria, a donor had been found, his doctor was ready to do the operation. Meanwhile, behind the scenes Humana employees scrambled to find a loophole in the patient’s contract. When they did, I was the one who had to tell the surgeon that the operation would not be covered.”

“The doctor asked me if I knew that the patient would likely die of his condition without the surgery, and I said I knew.” says Dr. Peeno. “When I hung up the phone my colleagues at Humana were thrilled, even joyful. I was sickened.”

In addition to Laura Dern, “Damaged Care” stars James LeGros, Adam Arkin, and Michelle Clunie, and features Regina King and Dianne Ladd. It will air on Showtime at 8 pm EST May 26 and May 29.

Dr. Peeno recalls that shortly after denying the patient their heart transplant, a gigantic piece of sculpture was purchased for Humana’s headquarters — costing about the same amount as the heart transplant she had denied.

“When HMO’s came on the scene, we were told that they would eliminate only the ‘inappropriate care’ and they would reduce costs so everyone could have insurance. Exactly the opposite has happened. They deny and delay needed care with sophisticated techniques, consume enormous resources for overhead costs and profits, and health care costs are rising dramatically.”

“Our corporate-dominated health care system is sick,” said Dr. Quentin Young, Past President of the American Public Health Association and National Coordinator of Physicians for a National Health Program. “It’s time to end the experiment with market-driven health care and adopt a non-profit national health insurance program.”

“The US health system is the most bureaucratic in the world, wasting over $150 billion annually on excessive paperwork,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard. “Meanwhile, 600,000 retired steelworkers just lost their health benefits and joined the ranks of the 40 million uninsured. There is more than enough money in our health system — over $4,300 per person — to provide quality health care for all if we exclude the corporate middleman and implement single payer national health insurance.”

When the film “John Q” came out — about a young man denied a heart transplant by his insurer — many people said that “it couldn’t happen in America.” “Damaged Care” not only shows that it is possible, but that because of the conflict between patients and profits, that it is inevitable.

####

Physicians for a National Health Program (PNHP) is an organization of over 9,000 physicians that supports a single payer national health insurance program. PNHP is based in Chicago with chapters across the US. For local contact information, call (312) 782-6006. www.pnhp.org

Dr. Linda Peeno is a family physician, medical ethicist and medical-legal consultant in Kentucky.

Rep. John Conyers is hosting the D.C. screening with Director Harry Winer.
Rep. Conyers will introduce legislation this spring calling for single payer national health insurance and excluding for-profit, investor-owned corporations in the delivery of health care.

“Damaged Care” Premiere Features HMO Whistleblower

Contacts:
Linda Peeno MD (502) 548-7878
Steffie Woolhandler MD (617) 665-1032
Quentin Young MD (312) 782-6006

Screening on Capitol Hill to be followed by panel with Dr. Linda Peeno,
Former HMO physician who denied a heart transplant

Former Humana Medical Evaluator Dr. Linda Peeno was so disturbed by what she experienced working for the giant HMO — including denying a young patient’s heart transplant — that she went into medical ethics and is now a vocal advocate for health care reform.

A film based on the experiences of Dr. Peeno, called “Damaged Care” and including a scene showing her denying a patient’s heart transplant, will have its world premiere on Capitol Hill on Friday, May 10. Laura Dern (“Jurassic Park”) plays Dr. Peeno. Dr. Peeno testified before Congress in May of 1996 about her heart transplant case and has been outspoken about the right to health care ever since.

“As a physician working for Humana, I denied a young man a heart transplant that would have saved his life, and thus caused his death,” testified Dr. Peeno. “No person or group has held me accountable for this, because, in fact, what I did was I saved a company a half a million dollars.”

“Humana’s only concern was costs,” says Dr. Peeno. “The young man fit all the criteria, a donor had been found, his doctor was ready to do the operation. Meanwhile, behind the scenes Humana employees scrambled to find a loophole in the patient’s contract. When they did, I was the one who had to tell the surgeon that the operation would not be covered.”

“The doctor asked me if I knew that the patient would likely die of his condition without the surgery, and I said I knew.” says Dr. Peeno. “When I hung up the phone my colleagues at Humana were thrilled, even joyful. I was sickened.”

In addition to Laura Dern, “Damaged Care” stars James LeGros, Adam Arkin, and Michelle Clunie, and features Regina King and Dianne Ladd. It will air on Showtime at 8 pm EST May 26 and May 29.

Dr. Peeno recalls that shortly after denying the patient their heart transplant, a gigantic piece of sculpture was purchased for Humana’s headquarters — costing about the same amount as the heart transplant she had denied.

“When HMO’s came on the scene, we were told that they would eliminate only the ‘inappropriate care’ and they would reduce costs so everyone could have insurance. Exactly the opposite has happened. They deny and delay needed care with sophisticated techniques, consume enormous resources for overhead costs and profits, and health care costs are rising dramatically.”

“Our corporate-dominated health care system is sick,” said Dr. Quentin Young, Past President of the American Public Health Association and National Coordinator of Physicians for a National Health Program. “It’s time to end the experiment with market-driven health care and adopt a non-profit national health insurance program.”

“The US health system is the most bureaucratic in the world, wasting over $150 billion annually on excessive paperwork,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard. “Meanwhile, 600,000 retired steelworkers just lost their health benefits and joined the ranks of the 40 million uninsured. There is more than enough money in our health system — over $4,300 per person — to provide quality health care for all if we exclude the corporate middleman and implement single payer national health insurance.”

When the film “John Q” came out — about a young man denied a heart transplant by his insurer — many people said that “it couldn’t happen in America.” “Damaged Care” not only shows that it is possible, but that because of the conflict between patients and profits, that it is inevitable.

####

Physicians for a National Health Program (PNHP) is an organization of over 9,000 physicians that supports a single payer national health insurance program. PNHP is based in Chicago with chapters across the US. For local contact information, call (312) 782-6006. www.pnhp.org

Dr. Linda Peeno is a family physician, medical ethicist and medical-legal consultant in Kentucky.

Rep. John Conyers is hosting the D.C. screening with Director Harry Winer.
Rep. Conyers will introduce legislation this spring calling for single payer national health insurance and excluding for-profit, investor-owned corporations in the delivery of health care.

Bleeding the Patient: The Consequences of Corporate Health Care

JAMA
May 1, 2002
Book Review by Jerrold P. Schwartz, M.D.

By David Himmelstein and Steffie Woolhandler with Ida Hellander Common Courage Press

“The seven years since the failed attempt of the Clinton administration to enact health care reform have seen the burgeoning of for-profit corporations in all aspects of health care. Giant health insurance and pharmaceutical corporations, for-profit hospital corporations with hundreds of hospitals, hemodialysis and nursing home chains, mental health and home care corporations, and many others less visible, such as quality-of-care and credentialing companies, are now well entrenched in our uniquely American system of health care and are profiting handsomely. But in the free-enterprise free-for-all, how are patients – and doctors – faring? To find out, read this book.”

“Judging by the tone of the book, the authors clearly uphold the US ideals of democracy and egalitarianism.”

“As advocates for our patients and to preserve the ethical underpinnings of our profession, all US physicians should read this compelling argument for medicine as a public service.”

Comment: “Bleeding the Patient” is available from the publisher, Common Courage Press at: http://www.commoncouragepress.com/himmelstein_bleeding.html

Professor Donald W. Light on Price Discrimination:

An old, dishonorable practice needs to be seen in a new light, namely making people without health insurance pay far more than others for needed health care. This especially affects immigrant groups, and among them, Latinos have the highest rate of uninsurance.

For decades, providers and especially hospitals, have kept raising their charges, far higher than their costs, in order to raise their “profile” for discount payments from government programs and insurers. Each year they raise the charges, and each year the payers respond by lowering the percentage of “charges” they will pay. This game is fine for those in them, and conversations about those not in them usually focus on Sheiks. In a recently conversation, a sub-specialist at a famous hospital was explaining how only millionaires and Sheiks pay full charges – they are so outrageous -and these windfall sums help pay for the uninsured.

But first, the uninsured are billed the “standard charges” (which no insured person pays). Then, when they cannot pay, bill collectors are sent, who attach their credit cards or homes (if they have one), and who threaten to report them to the INS. These charges are typically 3-6 times greater than what is normally collected from HMOs, insurers, and managed care plans. I recently experienced this personally, when a routine blood test was deemed not covered. The lab (a large national company) normally collects $85 for the test from discount contractors, but because they were billing me as an individual, their itemized bill was $401, more than 4 times greater. I got my physician to write a note and the bill was adjusted down to $85. If this had been for a hospitalization, the bill might have been $8500 to a plan or insurer, but $40,100 to an individual.

These practices have been documented by Consejo De Latinos Unidos, and they have a class action suit against Tenet, the huge managed care corporation, for ethnic discrimination. They have even shown in what unsystematic data they have been able to gather, that a hospital recovers more income from uninsured Latinos than from HMOs, i.e., the collection agents get them to pay a third of the bill, or $12,000 before taking them to court and/or getting them deported, when a routine payment would be $8500. Their material include a number of case studies that are an embarrassment to read.

Of course, Tenet replies they are doing what they always do, and that is correct. That’s “how the system works.” The judge on the case happened to speak about it off the record and comments that courts are not set up to change systems. In short, a dishonorable old practice of charge inflation has tragic consequences for the uninsured and especially for immigrants. All discussions about the uninsured, and about individualizing health care by having employees get health insurance for themselves, need to include these issues and practices.

Joanne Landy, Executive Director of the New York Chapter of Physicians for a National Health Program, responds to Rima Cohen on the Health Care Access Resolution – House Concurrent Resolution 99 (HCAR or HCR 99):

I was happy to see on the Q of the D that Rima Cohen, Vice President at the Greater New York Hospital Foundation and Director of the Insurance Options for the Uninsured Project, supports the Health Care Access Resolution – House Concurrent Resolution 99. As a statement committing Congress to enact universal health care by 2004, it is an urgent and necessary resolution.

It’s important to note that HCAR goes beyond calling for universal care; it calls for a guarantee that every person in the United States, regardless of income, age, or employment or health status, has access to decent, humane and affordable care, as detailed in the resolution (see below.)

It is important, however, to urge the public and members of Congress to work simultaneously for a single-payer health care system in the United States that can actually achieve the crucial goals enumerated in HCAR. A single payer system would create a universal risk pool and would finance health care through progressive taxation rather than through an employer-based system that depends on private insurance companies. A single payer system (essentially an improved and expanded Medicare-for-All) would save enormous amounts of precious health care dollars currently spent on marketing, on profits, and on the administrative costs built in to a system that forces providers to comply with hundreds of different insurance plans.

HCAR was introduced by U.S. Representative John Conyers, who is to be congratulated for his vision in doing so. He will shortly be introducing a single-payer health care bill, which will address the question of how to contain health care costs while assuring universal access to quality health care. I hope that Rima Cohen and other supporters of House Concurrent Resolution 99 support the Conyers single-payer bill as well.

HCAR calls for healthcare that: (1) is affordable to individuals and families, businesses and taxpayers and that removes financial barriers to needed care ; (2) is as cost efficient as possible, spending the maximum amount of dollars on direct patient care; (3) provides comprehensive benefits, including benefits for mental health and long term care services; (4) promotes prevention and early intervention; (5) includes parity for mental health and other services; (6) eliminates disparities in access to quality health care; (7) addresses the needs of people with special health care needs and underserved populations in rural and urban areas; (8) promotes quality and better health outcomes; (9) addresses the need to have adequate numbers of qualified health care caregivers, practitioners, and providers to guarantee timely access to quality care; (10) provides adequate and timely payments in order to guarantee access to providers; (11) fosters a strong network of health care facilities, including safety net providers; (12) ensures continuity of coverage and continuity of care; (13) maximizes consumer choice of health care providers and practitioners; and (14) is easy for patients, providers and practitioners to use and reduces paperwork.

Does anyone seriously believe that our private, employer based heath care system can deliver this package? To ask the question is to answer it.

–Joanne Landy Executive Director Physicians for a National Health Program New York Chapter

Comment: It is very easy to ask your member of Congress to support House Concurrent Resolution 99 by sending a message through the following link: http://www.house.gov/writerep/