By Philip Moeller
U.S. News and World Report
June 16, 2009

Health-care costs are the dominant cause of personal bankruptcies, according to a recent study based on detailed 2007 records and extensive interviews with people who filed for bankruptcy that year. The study was released for maximum impact amidst the Congressional debate over health-care reform, and it has been repeatedly cited as proof that the system needs fixing. While that may be a valuable outcome of the research, its underlying message will not be altered any time soon by reform efforts: health-care expenses are the largest uncontrollable expense that Americans face, and insurance does not make the problem go away. For seniors and those nearing traditional retirement age, setting aside funds for future health-care expenses simply must assume greater importance in financial plans.

More than 62 percent of personal bankruptcies in 2007 were related to medical expenses — up nearly 50 percent from 2001 — according to “Medical Bankruptcy in the United States, 2007.” Its authors, academics David U. Himmelstein, Deborah Thorne, Elizabeth Warren, and Steffie Woolhandler, said their work represented the first-ever national random survey of bankruptcy filers. The results were summarized in the American Journal of Medicine.

“Most medical debtors were well educated, owned homes, and had middle-class occupations,” the authors said, adding that nearly 80 percent of 2007 medical bankruptcies involved people who had health insurance at the time their medical problems began (60.3 percent with private insurance as their primary coverage, 10.2 percent with Medicare, 5.4 percent with Medicaid, and 2 percent with Veterans Affairs coverage).

Tougher bankruptcy rules were enacted several years ago; filings peaked in 2005 and then declined, the authors said. “Since then, filings have increased each quarter. They are likely to exceed one million households in 2008, representing about 2.7 million people.” According to Automated Access to Court Electronic Records, which tracks bankruptcies, personal filings have soared past the 6,000 per-day rate and may total 1.5 million this year.

In addition to being under-insured when their medical problems began, the 2007 study found that many people with private insurance coverage lost it after becoming ill. “Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year,” the study said.

In planning for future medical expenses, the study said:

“Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families: $26,971 for uninsured patients, $17,749 for those with private insurance at the outset, $14,633 for those with Medicaid, $12,021 for those with Medicare, and $6,545 for those with Veterans Affairs/military coverage. For patients who initially had private coverage but lost it, the family’s out-of-pocket expenses averaged $22,568.”

Hospital costs were the largest out-of-pocket expense for nearly half of the people filing for bankruptcy, followed by prescription drugs (19 percent), doctor’s bills (15 percent), and premiums (4 percent). Drugs were the major expense for patients with pulmonary, cardiac, or psychiatric illnesses. For a group of the most common medical conditions, the study found the highest out-of-pocket expenses were for non-stroke neurological illnesses such as multiple sclerosis ($34,167, expressed as a mean of expenses), followed by diabetes ($26,971), injuries ($25,096), stroke ($23,380), mental illnesses ($23,178), and heart disease ($21,955).

Editorial
Capital Times (Madison, WI)
6/10/2009

Dr. Linda Farley, the local physician and nationally recognized advocate for health care reform who died this week, had long championed the replacement of the current for-profit health care system with a single-payer plan. Such a plan would guarantee that all Americans have access to quality care while at the same time cutting costs associated with insurance and health care industry profiteering.

We have taken our counsel from Dr. Farley, and her husband, Dr. Gene Farley, on these issues for a number of years.

Our confidence in the experience and wisdom of these veteran physicians, who worked in a variety of public and private settings, has informed this newspaper’s commitment to the view that only a single-payer system will achieve the stated goals of President Barack Obama and congressional leaders. The Obama administration and Democrats and most Republicans in Congress say they want more and better care for all, with real flexibility for patients who want to keep the same doctor and genuine savings.

But we have also been informed over the years by Farley’s reminders that our current broken system does not merely make it harder for ailing Americans to get care and for healthy Americans to maintain their fitness. It also imposes incredible economic hardship on Americans who fall ill.

The extent of that hardship was revealed last week in a study that will be published this summer by the American Journal of Medicine. According to the study, medical problems contributed to almost 62.1 percent of all bankruptcies in 2007.

Worse yet, the data from the study show that, from 2001 to 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent.

That’s a particularly unsettling notion, as the current economic meltdown is all but sure to have caused an expansion of the crisis. Thus, as many as two-thirds of the 1.5 million Americans who are being forced into bankruptcy annually end up there because they made the “mistake” of getting sick.

And here is where things get downright scary. According to the study:

• Most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness.

• Most of the medically bankrupt fell into income categories that the authors of the study identify as “solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.

• In a substantial number of instances, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

“Our findings are frightening,” says Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy. For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain.”

Elizabeth Warren, the Leo Gottlieb professor of law at Harvard and one of the leading experts on personal bankruptcy, explains: “For many families, bankruptcy is a deeply shameful experience. People arrive at the bankruptcy courts exhausted — financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances.”

And more often than not, notes Warren, a co-author of the report, they arrive because they fell ill or suffered from a chronic condition.

Thus bankruptcy is not for the most part a matter of personal responsibility — or the lack thereof. It is a matter of bad health and a broken health care system.

How should we respond at a point when the United States is preparing to enter into another national health care debate?

Not with the gimmicks that members of Congress on both sides of the aisle and the Obama administration have been proposing, which leave most Americans in the grip of insurance companies that don’t provide adequate or humane coverage when people need it the most.

“We need to rethink health reform,” says Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., who is another co-author of the study. “Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance — stripped-down plans riddled with co-payments, deductibles and exclusions — won’t stem the rising tide of medical bankruptcy.”

Woolhandler is right.

Only the creation of a single-payer national health insurance system will address not just the health care crisis but the bankruptcy crisis.

As Dr. Linda Farley told us for years: “Single-payer is the cure.”

So how do we prescribe it?

The best way is by supporting the efforts of the group with which Farley was long associated: Physicians for a National Health Program, the real reform group that has won the support of more than 16,000 doctors nationwide.

To learn more about Physicians for a National Health Program, visit the group’s website at www.pnhp.org or call 312-782-6006.

http://www.madison.com/tct/opinion/454232

“Single-payer is the health system that works for every other industrialized nation on earth.”

By Sylvia Hampton
East County Magazine, California
6/16/09

Supporters of real health care reform want a national expansion of the popular Medicare single payer program now covering every American over age 65. But they are being told that it is just not “politically feasible.” When one asks “Why?” there is double talk and a run-around. The facts are clear. Oxen will be gored–and the industry and some in Congress are circling the wagons to protect their own self interests. We have some blatant conflicts of interest here that would make an eight-year-old blush: Congress members who have stock holdings in the industry and get large campaign contributions from insurers. Imagine that.

The insurance industry competes by selling large group insurance to businesses employing young healthy people. Ca-ching! They get those contracts by promising low cost to the employer, so the employee “contribution” becomes a pay deduction. Then if an employee gets sick or in an accident, his co-pays can become so large as to cause him to go bankrupt. But hey–no skin off the insurance company’s nose! Ca-ching.

If the sickness or injury is bad enough to lose your job they don’t have to mess with you anymore. They just drop you if you live long enough (after they do everything in their power to deny the claims.) After all, they have stockholders to think about–they must, by law, make a profit. Ca-ching. And because the drug companies don’t want to have to negotiate with the big bad government on prices, they stick with the captains of this industry like two peas in a private money pot. That’s what makes health insurance hooked to employment so darn great–for insurers. The result is that they have so much money they can scare the pants off everyone in government. They will run an ad campaign so slick a good guy will look like Satan when they are done.

Who gets the money for all those campaigns to sell insurance, sell drugs, sell the negative campaign ads? The Media. Ca-ching. So don’t ask them to help you gore that ox. That money talks–big time.

Single-payer is the health system that works for every other industrialized nation on Earth. Single-payer results in health statistics better than ours, costs the people far less than ours, and at the same time covers everyone in their country. But it was not given consideration in Congress and is deemed an evil communist plot by 30% of our population. The other 70% have caught on after hard knocks in our system and now support single payer/Medicare for all. But that is not even what the president is asking for; he just wants a “public option” in addition to the private plans.

But no, the industry says that is not fair. Why? Too many employers and workers will grab it in a heartbeat. Why? Better, cheaper, faster, nicer and more complete–like what all of us over 65 have and love: Medicare. The modern robber barons are throwing so much money and weight around Washington D.C. right now that you ordinary people out here in the real world don’t have a chance.

There is only one way you young ‘uns will get what I have–and that is to take to the streets and demand it. Call your congressman, demonstrate in the street by his office, call the talk shows, and scream bloody murder. Because murder is what is happening to you right now. They are killing you. But as long as insurers, drug companies and legislators make a profit and you don’t pay attention, their life goes on.

---

Sylvia Hampton is the past director of Health Care for All CA and a current board member of San Diegans for Health Care Coverage.

The views expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. If you wish to submit an editorial for consideration, contact editor@eastcountymagazine.org.

Dr. Margaret Flowers and Dr. Carol Paris
TruthDig
Jun 15, 2009

As the American Medical Association begins its annual convention in Chicago, we want to take this opportunity to make it clear to the American public, to the media, and to the president and members of Congress, that the AMA does not represent us. It is a common misconception that this organization speaks on behalf of most American physicians but that is a misconception with very serious consequences at such a critical time in the health care reform debate. So long as the public, the media and our elected officials lump all physicians together as “the AMA,” then we are guilty by association of a failure of our Hippocratic oath to “first, do no harm.”

In fact, the AMA represents less than one-third of America’s physicians, and half of those are retired. In fact, the American Medical Student Association endorses universal health care reform.

The AMA’s longstanding opposition to every effort to change health care financing, including Medicare in the 1960s, has resulted in decades of needless and countless morbidity and mortality. Sixty people die every day in this country simply for lack of access to health care. And instead of being an advocate for the only solution that accomplishes the goals of universal coverage and fiscal viability, the single-payer option, the AMA continues to be primarily a trade association looking out for the financial interests of its members.

But who, then, is looking out for the interests of patients? Certainly not Congress and the president. If that were so, the United States would long ago have relieved itself of the dubious distinction of being the only developed country in the world that does not have a universal system of health care. No, the evidence is clear that our Congress and our president are looking out for themselves and continuing the tradition of pay-to-play politics. How else would a reasonable person explain the fact that our elected officials, Democrats and Republicans combined, have accepted $12 million in campaign contributions since 1998 from the American Medical Association?

We would suggest that the American people, the media, President Obama, and the members of Congress need look no further than PNHP, Physicians for a National Health Program, if they want to consult an organization that represents the interests of patients and has been doing so for 22 years.

We are proud members of PNHP. We’re waiting and eager to be consulted. And our physicians are willing and able to continue to engage in acts of nonviolent civil disobedience. Health care reform is the civil rights issue of the decade.

The AMA does not represent us.

---

Dr. Margaret Flowers and Dr. Carol Paris are members of Physicians for a National Health Program.

By Alison Knezevich
The Charleston Gazette
June 14, 2009

CHARLESTON, W.Va. — Moving boxes are stacked in the living room of Andrew and Rita Watson’s Kanawha City apartment.

The Australian immigrants are preparing for a trip neither wants to make.

“I don’t have any insurance, and I’m uninsurable,” 65-year-old Andrew Watson said.

And that could send him back to Australia.

In 1989, Australian surgeons replaced his right hip. He never got a hospital bill.

Since 1984, the country has offered universal health care through a program called Medicare, a government-operated system funded by taxes. Australians can also choose to use private insurance.

Last October, Watson’s hip replacement gave out. It was 19 years to the day he got it, he said.

He believes it’s wearing its way into the bone of his pelvic girdle. He’s sore all the time and walks with a cane.

Surgery would cost more than $50,000, he said.

In 1993, the couple settled in Charleston to be closer to Rita Watson’s children. In America, they’ve never had health insurance.

Watson pointed to his plastic green Australian Medicare card. He has dual American-Australian citizenship.

When he gets to Australia, “I’m just going to present that and say nothing.”

He plans to go by himself. If he must stay for a long period of time, he says his wife will follow.

The Watsons’ struggles come as health-care reform takes center stage in Washington, D.C. President Barack Obama and Congress are preparing legislation to overhaul the nation’s health-care system, though many questions remain unanswered.

The Watsons say their experience has given them a unique perspective. For the past seven months, they’ve worked with the state chapter of a national group called Physicians for a National Health Program to promote “single-payer” health care.

“The American people deserve it,” said Rita Watson, 71. “They’re very, very hardworking.”

They know many Americans don’t like the idea. Critics say it would lead to long waits and poor care.

Many others haven’t heard of it. A few weeks ago, Rita Watson’s son visited from Elkview.

“I brought up single-payer,” she said. “He said, ‘What’s that?'”

The single-payer system would work like America’s Medicare program for the elderly. A government-run agency, financed by taxes on employers and employees, would collect fees and pay them out to providers.

Everyone would be covered, and no one would pay co-payments or deductibles.

Proponents say the current for-profit insurance system denies people the care they need and is mired in administrative waste that drives up costs.

In December, the couple attended a meeting for Obama supporters. The conversation turned to health care.

They met Dr. Hedda Haning, an anesthesiologist with Physicians for a National Health Program.

“He got up with an obvious accent,” Haning said. “People were very interested to hear, because he was someone from elsewhere.”

Now retired, Andrew Watson has worked as an industrial plant maintenance mechanic, and maintained machines for a records management company, among other jobs. He never made enough money to pay insurance premiums.

Rita Watson has worked for a gas company, the state, and a behavioral health agency.

“I was in temporary work, and I always got 39 hours,” an hour short of qualifying for benefits, she said.

In 2004, a blood infection sent Andrew Watson to Charleston Area Medical Center for 11 days. After that, he needed bandages, saline solution and other supplies to take care of his wounds at home. His bill: $26,000.

The CAMC doctors “saved my life,” he said.

“There’s nothing wrong with the health care,” he said. “It is the way the funding and the billing is managed. And that is the trouble in the Untied States.”

Last month, the Watsons visited Washington, D.C., with Physicians for a National Health Program to lobby representatives.

When they visit the grocery store, they wear “Single Payer” buttons with the slogan, “Everybody in, nobody out.”

“It’s about equity,” he said.

Much of the debate in Washington now centers around whether a “public option” — a government-sponsored insurance plan to compete with the private industry — will be available. Obama supports such a plan. Critics say it’s a backdoor to a single-payer system.

“There are various things that have been talked about in the last week or so, but what happens next is anybody’s guess,” said Haning, who’s been pushing for a single-payer system for about 20 years. “It seems that Congress wants to protect the insurance companies.”

In Kanawha City, Rita Watson said she and her husband are “hoping and praying” that somehow, they won’t have to leave the United States.

“The American people are tops,” she said. “There’s no one like them…. Australia is a beautiful country. But it’s not America. This is home.”

By Judy Norsigian and Jennifer Potter
The Boston Globe
June 15, 2009

A single-payer healthcare system would more effectively control costs than any other plan that Congress is considering as it moves toward a reform bill. And by controlling costs, existing resources could be allocated more equitably, especially for the benefit of women.

First, single-payer plans eliminate the $300 billion to $400 billion that insurance companies spend annually in administrative overhead and waste. Second, single-payer plans are best positioned to take on the enormous challenge of reducing or eliminating the financial incentives that have led to so much overtreatment and undertreatment.

Maternity care illustrates this phenomenon: We spend far more per capita than any other industrialized country and yet do worse on most birth outcome measures than most of these other countries. So-called best practices – medical practices already demonstrated to improve outcomes – are well described in the medical literature, but they are not widely implemented, even though doing so would lower costs and improve the health of mothers and babies.

For example, nearly one-third of all US women deliver their babies by caesarean section, a rate that is far higher than medically necessary. One of the reasons is that most obstetricians and hospitals are paid far more for a surgical delivery than for a vaginal birth. Such incentives not only raise costs, but ironically often produce worse health outcomes.

By reducing the ability of for-profit companies to siphon off huge sums of money for private gain, a single payer system is better able to expand best practices. Why? Because the motivations to over-treat those who are well-insured and to undertreat those with limited or no insurance coverage will no longer be built into the medical care system.

Women in particular have much to gain from single-payer healthcare. Our country has an excess of medical specialists, and is in desperate need of more primary caregivers – such as general internists, family practice physicians, nurse practitioners, and licensed midwives – who are often more aptly trained than specialists to provide the comprehensive services women need. A single payer plan would eliminate the financial incentives that have been obstacles to training more primary care professionals. It would also eliminate the need for so many medical malpractice lawsuits, as people would not have to worry about paying for medical care whenever they experienced bad outcomes.

The only national plan for healthcare reform that explicitly includes women’s reproductive health services, including abortion, is one sponsored by Representative Barbara Lee, a California Democrat. Other sponsors of single-payer plans are also amenable to including women’s reproductive health services.

Coverage with a single-payer plan is independent from employment. Because women are more likely to be self-employed, to work part time, and to move in and out of employment outside the home, they are now more likely either to lack coverage through work or to lose insurance when changing jobs.

Medical debt is an enormous concern for many women, and single-payer plans effectively address the cost issues that send women into debt and even bankruptcy. A 2009 Commonwealth Fund study found that 45 percent of women accrued medical debt or reported problems with medical bills in 2007 compared with 36 percent of men. Under Rep. John Conyers’ single-payer bill, a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs – with no deductibles or copays or concerns about catastrophic costs.

Since a single-payer plan may be the only approach that will successfully contain costs, it was a good sign that Congress finally held hearings on a single-payer system last week.

Although many progressive members of Congress now support a proposal that includes a “public insurance option” as an alternative to private insurance industry plans, numerous critiques demonstrate how this approach could fail. Unless designed to mirror the effective Medicare system – by automatically enrolling the majority of the population and using Medicare’s cost control levers – the public option will not be affordable for all.

When polled, a majority of physicians as well as the public support a single-payer plan. For example, a 2007 AP-Yahoo poll asked respondents whether they agreed with this statement: “The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.”

A whopping 65 percent said yes to that question. By political standards, this is a landslide. It is time for Congress to pay attention to the voters, not the well-funded lobbyists.

---

Judy Norsigian is executive director of Our Bodies Ourselves. Jennifer Potter, MD, is director of the Women’s Health Center at Beth Israel Deaconess Medical Center and director of women’s health at Fenway Health.

By Alison Knezevich
The Charleston Gazette
June 14, 2009

CHARLESTON, W.Va. — Moving boxes are stacked in the living room of Andrew and Rita Watson’s Kanawha City apartment.

The Australian immigrants are preparing for a trip neither wants to make.

“I don’t have any insurance, and I’m uninsurable,” 65-year-old Andrew Watson said.

And that could send him back to Australia.

In 1989, Australian surgeons replaced his right hip. He never got a hospital bill.

Since 1984, the country has offered universal health care through a program called Medicare, a government-operated system funded by taxes. Australians can also choose to use private insurance.

Last October, Watson’s hip replacement gave out. It was 19 years to the day he got it, he said.

He believes it’s wearing its way into the bone of his pelvic girdle. He’s sore all the time and walks with a cane.

Surgery would cost more than $50,000, he said.

In 1993, the couple settled in Charleston to be closer to Rita Watson’s children. In America, they’ve never had health insurance.

Watson pointed to his plastic green Australian Medicare card. He has dual American-Australian citizenship.

When he gets to Australia, “I’m just going to present that and say nothing.”

He plans to go by himself. If he must stay for a long period of time, he says his wife will follow.

The Watsons’ struggles come as health-care reform takes center stage in Washington, D.C. President Barack Obama and Congress are preparing legislation to overhaul the nation’s health-care system, though many questions remain unanswered.

The Watsons say their experience has given them a unique perspective. For the past seven months, they’ve worked with the state chapter of a national group called Physicians for a National Health Program to promote “single-payer” health care.

“The American people deserve it,” said Rita Watson, 71. “They’re very, very hardworking.”

They know many Americans don’t like the idea. Critics say it would lead to long waits and poor care.

Many others haven’t heard of it. A few weeks ago, Rita Watson’s son visited from Elkview.

“I brought up single-payer,” she said. “He said, ‘What’s that?'”

The single-payer system would work like America’s Medicare program for the elderly. A government-run agency, financed by taxes on employers and employees, would collect fees and pay them out to providers.

Everyone would be covered, and no one would pay co-payments or deductibles.

Proponents say the current for-profit insurance system denies people the care they need and is mired in administrative waste that drives up costs.

In December, the couple attended a meeting for Obama supporters. The conversation turned to health care.

They met Dr. Hedda Haning, an anesthesiologist with Physicians for a National Health Program.

“He got up with an obvious accent,” Haning said. “People were very interested to hear, because he was someone from elsewhere.”

Now retired, Andrew Watson has worked as an industrial plant maintenance mechanic, and maintained machines for a records management company, among other jobs. He never made enough money to pay insurance premiums.

Rita Watson has worked for a gas company, the state, and a behavioral health agency.

“I was in temporary work, and I always got 39 hours,” an hour short of qualifying for benefits, she said.

In 2004, a blood infection sent Andrew Watson to Charleston Area Medical Center for 11 days. After that, he needed bandages, saline solution and other supplies to take care of his wounds at home. His bill: $26,000.

The CAMC doctors “saved my life,” he said.

“There’s nothing wrong with the health care,” he said. “It is the way the funding and the billing is managed. And that is the trouble in the Untied States.”

Last month, the Watsons visited Washington, D.C., with Physicians for a National Health Program to lobby representatives.

When they visit the grocery store, they wear “Single Payer” buttons with the slogan, “Everybody in, nobody out.”

“It’s about equity,” he said.

Much of the debate in Washington now centers around whether a “public option” — a government-sponsored insurance plan to compete with the private industry — will be available. Obama supports such a plan. Critics say it’s a backdoor to a single-payer system.

“There are various things that have been talked about in the last week or so, but what happens next is anybody’s guess,” said Haning, who’s been pushing for a single-payer system for about 20 years. “It seems that Congress wants to protect the insurance companies.”

In Kanawha City, Rita Watson said she and her husband are “hoping and praying” that somehow, they won’t have to leave the United States.

“The American people are tops,” she said. “There’s no one like them…. Australia is a beautiful country. But it’s not America. This is home.”