PNHP

How Do You Think Your Healthcare is Trading?

How Do You Think Your Healthcare is Trading?

By Donna Smith
Community Organizer
California Nurses Association

CHICAGO — If you think the companies that collect your health insurance premiums and pay your health care claims have been insulated from the economic crisis, think again. And if you think the health insurance industry that is suffering right alongside the financial services industry isn’t going to need a bail-out too, think yet again. Only the bail-out we will give the health insurance industry will be much more insidious and potentially far more dangerous to us all.

I wanted to inform myself about the stock performance of the big boys in the for-profit health insurance market, and here’s what I found this morning on Business Week’s website:

Stock performance, over the past month:

Aetna — down 25.03%

CIGNA — down 23.15 %

Humana — down 20.16%

Unitedhealth Group — down 27.95%

Wellpoint — down 20.59%

In fact, I couldn’t find one health insurance company traded on the stock exchange that looked very healthy right now. On its own, that’s not an indictment of the health insurance industry because so many businesses — if not most businesses — are losing money on Wall Street right now.

While the financial services industries were the first to the trough for bail-out, they won’t be the only private interests standing in line for some of our taxpayers’ funds. But when the private, for-profit health insurance industry comes calling, it will do so by raising premiums, denying claims and seeking to cover more Americans who won’t actually need to use many medical services. There are limited ways for the health insurance giants to recoup losses, and we are the way — our money, our ability to get the care we need and our lives depend on getting healthcare out of this folly.

We all know it. Healthcare isn’t like widgets or tires or hammers and nails. Healthcare is a human right. When we are sick, when our neighbor is sick, when our parent is sick, when our child is sick, and yes — even when our enemies are sick — we must have access to medical care. To see a doctor or other healthcare professional when we need it (and before it has become a crisis) is the way a humane and just society behaves.

But under the current, market sensitive and market driven pressures, healthcare morphs into a sort of odd blend of wealth-care for those who can still afford it as approved by for-profit insurance companies with enough resources to pay the claims. We can argue all we want to about the art of medicine, but when Unitedhealth Group drops nearly 30 percent in value in just one month, there isn’t any art to what they’ll be doing to the practice of medicine.

As a patient, I do not want my healthcare subject to the whims and the momentary fortunes of the stock market. I do not want to gamble on my healthcare or my children’s or my grandchildren’s. And I certainly don’t think the CEOs of those big corporations will want to take reductions in compensation or allow shareholders to suffer. Ronald Williams at Aetna, Edward Hanway at Cigna, Michael McCallister at Humana and Stephen Hemsley at Unitedhealth Group surely want to retain their millions in compensation even if that means denying me my prescription or my treatment or raising my premiums.

Any corporate losses resulting from the massive drops in value to the private health insurance industry in the current stock market environment will be absorbed by policy holders. You and me. Our employers. Our neighbors. Our families. Our health is in the hands of the stock market not those of our doctors and other healthcare professionals. And right now, my healthcare is worth a lot less than it was on Labor Day.

The only alternative to gambling with our healthcare in this volatile way is to make sure public funding backs up the healthcare system.

And I don’t know about other taxpayers — but I suspect many will feel as I do — I don’t want the funds I earn and the funds my taxes put in the public coffers to be used to pay for yet another corporate bail-out at my expense. I’ll gladly pay for my healthcare through a public fund but not their wealthcare. How does the saying go? Been there. Done that.

I do not want to pay monthly premiums and on top of those premiums to fund a bail-out to shore up health insurance company CEO compensation or shareholder dividends. And I cannot invest in the stock market by paying my health insurance premiums on time and wait for the market recovery in the estimated five to 10 years to recoup the investment. I might get sick and need actual healthcare.

I want the funds I contribute to healthcare to be used for healthcare. Period.

Health Care Systems – Four Basic Models

An excerpt from correspondent T.R. Reid’s book on international health care, titled “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.” There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills. But we don’t have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns. There are four basic systems:

The Beveridge Model

Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library. Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge. Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction. Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides. The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance. The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated. The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

The Out-of-Pocket Model

Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die. In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease. In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care. These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you’re sick enough to be admitted to the emergency ward at the public hospital. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.

Note – Reid’s “Beveridge” model corresponds to what PNHP would call a single payer national health service (UK); “Bismark” model refers to countries that PNHP would say use non-profit “sickness funds” or a “social insurance model” (Germany); and “National health insurance” corresponds to single payer national health insurance (Canada, Taiwan). Reid’s “out-of-pocket” model is what PNHP would call “market driven” health care. Some countries have mixed models (e.g. Sweden has some features of a national health service such as hospitals run by county government; but other features of national health insurance such as physicians being paid on a FFS basis). This explains why Reid might classify the Scandinavian systems as “Beveridge” while PNHP classifies them as “single payer national health insurance.”

What reform does business want?

Business Cool Toward McCain’s Health Coverage Plan

By Kevin Sack
The New York Times
October 6, 2008
American business, typically a reliable Republican cheerleader, is decidedly lukewarm about Senator John McCain’s proposal to overhaul the health care system by revamping the tax treatment of health benefits, officials with leading trade groups say.
The officials, with organizations like the U.S. Chamber of Commerce, the Business Roundtable and the National Federation of Independent Business, predicted in recent interviews that the McCain plan, which eliminates the exclusion of health benefits from income taxes, would accelerate the erosion of employer-sponsored health insurance and do little to reduce the number of uninsured from 45 million.
Officials with eight business trade groups contacted by The New York Times predicted the McCain plan would raise costs and force some employers to stop providing health benefits.
A recent survey of 187 corporate executives by the American Benefits Council and Miller & Chevalier, a consulting firm, found that three-fourths felt the repeal of the tax exclusion would have a “strong negative impact” on their workers. Only 4 percent said they would provide additional pay to fill any gaps.
http://www.nytimes.com/2008/10/07/us/politics/07health.html?pagewanted=all

Where does American business really stand on health care reform?
Employers remain very concerned about rising health care costs. Because of our failure to reform our health care financing system, employers have been responding by shifting more responsibility to their employees. There has been an increase in the use of high-deductible health plans, which slow the rate of premium increases for the employer, but makes health care less affordable for the employees by requiring greater out-of-pocket payments when health care is accessed. Many employers now have decided not to offer health plans; the rate of coverage through employer-sponsored plans has continued to decline, especially amongst small businesses.
The McCain proposal is designed to relieve employers of the responsibility of providing employer-sponsored plans, both by eliminating the tax benefit for the employees and by offering individuals tax credits for purchasing plans in the individual market. It is not only the Obama camp that recognizes the erosion of health coverage that this would cause, the business community recognizes it as well. Most American businessmen are concerned about the welfare of their employees. They really don’t want a solution that would have a “strong negative impact” on their employees.
So would business be more supportive of the Obama proposal? The most important component of his proposal is to offer a market of quality plans similar to those used by federal employees. But isn’t that what they have now? Isn’t that precisely why the business community is seeking relief? Even Barack Obama understands that these plans are too expensive, and many would still have to go without coverage.
The American business leadership certainly understands the single payer model. One of the most important principles for a successful business is to reduce waste, and that is precisely what the single payer model does, by design. Adopting a single payer system would allow us to cover everyone, and would allow us to finance it equitably through a single universal risk pool.
When we desperately need sound business principles to drive health care financing, it really seems silly to digress into a not-very-intellectual debate over free markets and the government, as if they were two distinct entities between which a choice had to be made. Nebulous debates lead to nebulous results (and is probably the reason why conservatives keep drawing us into that debate).
Some leaders in the business community must be ready to support sound business principles in revamping our highly flawed health care financing system. An intellectual debate over ideology might make for an interesting pastime, but first we have to get our dollars in order. Every businessman understands that.

What reform does business want?

Business Cool Toward McCain's Health Coverage Plan

By Kevin Sack
The New York Times
October 6, 2008

American business, typically a reliable Republican cheerleader, is decidedly lukewarm about Senator John McCain’s proposal to overhaul the health care system by revamping the tax treatment of health benefits, officials with leading trade groups say.

The officials, with organizations like the U.S. Chamber of Commerce, the Business Roundtable and the National Federation of Independent Business, predicted in recent interviews that the McCain plan, which eliminates the exclusion of health benefits from income taxes, would accelerate the erosion of employer-sponsored health insurance and do little to reduce the number of uninsured from 45 million.

Officials with eight business trade groups contacted by The New York Times predicted the McCain plan would raise costs and force some employers to stop providing health benefits.

A recent survey of 187 corporate executives by the American Benefits Council and Miller & Chevalier, a consulting firm, found that three-fourths felt the repeal of the tax exclusion would have a “strong negative impact” on their workers. Only 4 percent said they would provide additional pay to fill any gaps.

http://www.nytimes.com/2008/10/07/us/politics/07health.html?pagewanted=all

Comment:

By Don McCanne, MD

Where does American business really stand on health care reform?

Employers remain very concerned about rising health care costs. Because of our failure to reform our health care financing system, employers have been responding by shifting more responsibility to their employees. There has been an increase in the use of high-deductible health plans, which slow the rate of premium increases for the employer, but makes health care less affordable for the employees by requiring greater out-of-pocket payments when health care is accessed. Many employers now have decided not to offer health plans; the rate of coverage through employer-sponsored plans has continued to decline, especially amongst small businesses.

The McCain proposal is designed to relieve employers of the responsibility of providing employer-sponsored plans, both by eliminating the tax benefit for the employees and by offering individuals tax credits for purchasing plans in the individual market. It is not only the Obama camp that recognizes the erosion of health coverage that this would cause, the business community recognizes it as well. Most American businessmen are concerned about the welfare of their employees. They really don’t want a solution that would have a “strong negative impact” on their employees.

So would business be more supportive of the Obama proposal? The most important component of his proposal is to offer a market of quality plans similar to those used by federal employees. But isn’t that what they have now? Isn’t that precisely why the business community is seeking relief? Even Barack Obama understands that these plans are too expensive, and many would still have to go without coverage.

The American business leadership certainly understands the single payer model. One of the most important principles for a successful business is to reduce waste, and that is precisely what the single payer model does, by design. Adopting a single payer system would allow us to cover everyone, and would allow us to finance it equitably through a single universal risk pool.

When we desperately need sound business principles to drive health care financing, it really seems silly to digress into a not-very-intellectual debate over free markets and the government, as if they were two distinct entities between which a choice had to be made. Nebulous debates lead to nebulous results (and is probably the reason why conservatives keep drawing us into that debate).

Some leaders in the business community must be ready to support sound business principles in revamping our highly flawed health care financing system. An intellectual debate over ideology might make for an interesting pastime, but first we have to get our dollars in order. Every businessman understands that.

In Pennsylvania, churches back single payer

By Morton Mintz
Nieman Watchdog
Commentary
October 05, 2008

Morton Mintz relays comments by the director of Public Advocacy of the Pennsylvania Council of Churches holding that health care “is very much an issue for the faith community.”

Are there good questions that reporters could ask of religious leaders in their communities about the morality of a system that leaves 46 million Americans without health insurance, millions more with inadequate coverage, and, because of the economic crisis, guarantees big increases in these numbers? Are there also good questions about that same system that reporters could put to businessmen in their communities? Indeed there are, as I learned at a health care conference at Franklin & Marshall College in Lancaster, Pa., on Sept. 18.

Few others were privileged to have had the same learning experience, the conference having received zero news coverage until seven days later, when a report by columnist Jeff Hawkes ran in the local paper, the Intelligencer Journal.

The conference sponsor, Progressives4Pennsylvania, seeks to make Pennsylvania the first state to adopt the form of universal health insurance known as single-payer. It is essentially Medicare for all, meaning that everyone – not just elders – would get private care paid for by the government, and with administrative costs far lower than those of private insurance. It is not socialized medicine, in which a national government, Great Britain’s being a case in point, owns and operates the health care system. (Disclosure: I was one of 15 panelists, my topic being press coverage – and non-coverage – of universal health care systems, particularly single-payer in Canada.)

The focus of this article is on the panelist whose remarks suggest questions for religious leaders. She is the Rev. Sandra L. Strauss, an ordained Minister of Word and Sacrament in the Presbyterian Church (USA) who holds a Master of Arts in Public Policy Studies from Duke University. But she spoke as Director of Public Advocacy for the Pennsylvania Council of Churches, which endorses single-payer for her state.

Does the Council’s counterpart in, say Ohio, endorse single-payer, and if it does, why, and if it does not, why not?

She said early on that “health care is very much an issue for the faith community.” Do ministers, priests and rabbis in, say South Carolina, agree or disagree, and why?

Such obvious questions flow in abundance from her full but brief prepared text, which follows:

I begin by sharing a few words from the Rev. Dr. Martin Luther King, Jr.: “Of all forms of inequality, injustice in health care is the most shocking and inhumane.” Sadly, it seems that not only have inequalities continued, they appear to be growing worse.

A colleague in another state asked his constituents the following question: What does it mean for us, as members of Christ’s body in the world, to carry on Jesus’ work of bringing hope and healing to all?

As this question suggests, health care is very much an issue for the faith community. As Protestant Christians–the constituency I represent–our concerns are shaped by the biblical principles of stewardship and justice.

It seems that our nation’s economic and political institutions, by and large, have not been good stewards of the resources that our society allocates to health care. We fail to be good stewards of our nation’s health care resources when Americans spend two to three times as much per person as other industrialized countries-and our overall health outcomes are worse!

In addition, disparities in health care coverage raise serious questions about the overall justice of our present system. All persons are precious in the eyes of God. No person’s well-being can be reduced to a price and bought and sold without moral and ethical considerations. Persons are more than “consumers” of the goods and services produced by the health care system: all are entitled to care, respect, and compassion, regardless of their state of health, their medical history, their personal circumstances, or their ability to pay.

As Christians, we believe that all creation is sacred, precious and worthy of being safeguarded. We believe that we are called to pursue justice and to practice love and compassion. We believe that we have a responsibility for stewardship, especially for stewardship of those resources that protect the well-being of human lives.

Finally, we believe that we are called to action to advocate and work for the well-being of poor and marginalized persons, as summed up by these words from the prophet Isaiah: “Seek justice, rescue the oppressed, defend the orphan, plead for the widow.” Orphans and widows were considered the most vulnerable members of the society of Isaiah’s time-and at the time of Jesus. This includes advocating for access to comprehensive and affordable health care for ALL persons, access not based solely on wealth, population, or other arbitrary determinant. Health care coverage must be for everyone. The religious conscience will accept nothing less.

The Pennsylvania Council of Churches has chosen to support the only proposal that addresses both of these concerns for Pennsylvania-the Family and Business Health Security Act, which would provide for a publicly administered system that covers all Pennsylvanians, but also maintains individual choice of comprehensive, privately delivered health care.

In closing, I want to remind all of you here that Jesus was a healer–and healing was one of the most important aspects of Jesus’ ministry. The gospels are replete with stories of Jesus healing the sick, raising the dead, restoring sight to the blind and hearing to the deaf, and making lame persons walk. He cared deeply for the spiritual welfare of all as well. He empowered others “to proclaim the kingdom of God and to heal” (Luke 9:2). He never refused to heal someone because they could not pay, and obviously preexisting conditions were his specialty. It seems to me that Jesus would provide for the health and well-being of all persons.

While I can’t claim that Jesus would endorse this legislation, I suspect that He would be happy to know that we are working, as He did, to provide health and healing for everyone…because I doubt that He would settle for anything less.

Some memorable context for the Rev. Strauss’s remarks came from a fellow panelist, a physician from the Department of Family and Community Medicine at Lancaster General Hospital. Here’s columnist Hawkes’s account:

Dr. Thomas Gates also joined the call for universal health care, having seen how the uninsured suffer when they put off treatment.

Citing an Institute of Medicine report, Gates said an uninsured person is twice as likely as an insured one to require a hospital stay for a preventable illness such as pneumonia or diabetes. Uninsured cancer patients delay care, resulting in a 50 percent higher chance of dying from the disease. Uninsured patients in general, he said, have a hospital mortality rate three times that of the insured because they delay going to the emergency room.

Gates has seen firsthand the problems. He recalled the time an uninsured blue-collar worker, a family man in his mid-20s, was admitted at Lancaster General Hospital after avoiding care until he was too weak to stand.

When the man arrived at the ER, he was diagnosed with new-onset diabetes and blood sugar levels off the chart [2,500]. His organs failed, and within 24 hours he was dead.

“His death certificate, I’m sure, says complications from diabetes,” Gates said. “But in reflecting on this, it would be just as accurate and just as true to say he died from lack of health care insurance.”

Morton Mintz is a senior adviser to the Nieman Watchdog project of the Nieman Foundation for Journalism at Harvard University.

Beware 'siren song' of privatizers, U.S. doctor tells Canadians

FOR IMMEDIATE RELEASE:
Oct. 7, 2008

Contact:
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, mark@pnhp.org

Canada’s publicly funded health insurance program known as medicare “is one of the best health care systems in the world,” a leading U.S. health policy expert says, but is being threatened by government underfunding and by those who would partially privatize it under the guise of reducing wait times for elective medical procedures.

Dr. Marcia Angell, a senior lecturer at Harvard Medical School, writes in the Oct. 21 issue of the Canadian Medical Association Journal (CMAJ) that Canada’s health expenditures are half those in the United States – US$3,326 per person versus US$6,697. Yet, in sharp contrast to the U.S., Canada’s health system guarantees essential medical care to all of the country’s residents.

In addition, Angell says, since the full implementation of medicare in 1972, Canada’s medical outcomes have surpassed those of the U.S. “The life expectancy of Americans is now 2.5 years shorter than that of Canadians,” she writes. “Infant mortality rates are higher in the U.S., as is preventable mortality (death before the age of 75 from diseases that are amenable to treatment).” Americans also visit their doctors much less often than their Canadian counterparts.

Saying the only plausible explanation for the U.S. spending more and getting less than Canada is that the U.S. system is “enormously inefficient,” an inefficiency that stems from relying “primarily on private, largely investor-owned corporations to provide health care.”

These for-profit health insurance companies, hospitals, and “satellite businesses that have sprung up around the health care industry” like drug-management companies, utilization review companies and billing agencies siphon off about 31 percent of all health care spending in the U.S. for administrative costs, marketing and profits, she says.

By contrast, she writes, Canada’s public system and the U.S. Medicare system incur administrative costs of 2 percent or less.

The main charge leveled against Canada’s system is that it requires excessive wait times, particularly for elective procedures, Angell says.

Waiting times are a concern, she says. Some waits were lengthened when Canada adopted a 1984 law that essentially abolished user fees and extra charges. To compensate, system administrators tried to contain costs by controlling the supply of services like imaging and the use of surgical facilities, leading to longer waits.

Wait times also increased in the 1990s, when the Canadian system was badly underfunded. The funding became a political issue, and while subsequent funding improved the situation, today “waiting times are still too long for certain elective procedures, such as hip and knee replacements, and it takes time for increased funding to be translated into more facilities and specialists.”

But waiting lists for these procedures are no reason to abandon what clearly amounts to a superior overall system of delivering health care, a system that provides essential health care to all based on medical need, not ability to pay, Angell says. Canadian medicare still remains popular with the public, she notes.

Those who say that privatizing part of Canada’s system will reduce wait times have produced little evidence to back up their claim, she says. In fact, Angell believes the pressure to partially privatize the Canadian system has more to do with “the desire of businesses and some specialists to profit from the system, just as they do in the U.S.,” combined with a desire on the part of federal and provincial governments to shift more health care costs onto individual patients.

Such steps toward privatization would backfire, she says, since “for-profit care is nearly always more expensive and often of lower quality.”

Instead, she urges better funding for Canada’s medicare. “The wisest course for Canada is to expand and reinforce its public system, not undermine it,” Angell says.

Angell, the former editor-in-chief of The New England Journal of Medicine, notes that many Americans also appreciate the merits of a national health insurance system: “Polls have shown that about two-thirds of Americans would prefer a Canadian-style system, as would three-fifths of doctors.”

An early release version of Dr. Angell’s paper (“Privatizing health care is not the answer: lessons from the United States,” Marcia Angell, CMAJ, www.cmaj.ca, Oct. 21, 2008) can be found here: www.pnhp.org/Canada_medicare.

###

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, call (312) 782-6006 or visit www.pnhp.org/stateactions.

Medical causes of home mortgage foreclosures

Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures

By Christopher Tarver Robertson, Richard Egelhof, & Michael Hoke
Health Matrix
Vol. 18:65 2008
In recent years, there has been national alarm about the rising rate of home foreclosures, which now strike one in every 92 households in America, and which contribute to even broader macroeconomic effects.
These factors — loose lending, irresponsible borrowers, a flat real estate market, and rising interest rates — have together become the “standard account” of home foreclosure.
Policymakers and scholars may be surprised to learn that even in the midst of this spike, one of the largest causes of home foreclosures was none of the above. We studied homeowners going through foreclosure in four states and found that medical crises contribute to half of all home foreclosure filings. If these patterns hold nationwide, medical causes may put as many as 1.5 million Americans in jeopardy of losing their homes each year.
Half of all respondents (49%) indicated that their foreclosure was caused in part by a medical problem, including illness or injuries (32%), unmanageable medical bills (23%), lost work due to a medical problem (27%), or caring for sick family members (14%). We also examined objective indicia of medical disruptions in the previous two years, including those respondents paying more than $2,000 of medical bills out of pocket (37%), those losing two or more weeks of work because of injury or illness (30%), those currently disabled and unable to work (8%), and those who used their home equity to pay medical bills (13%). Altogether, we found that about 7 in 10 of our respondents either self-reported a medical cause of foreclosure, or experienced one of these indicia of medical disruptions in the years before foreclosure.
Altogether, these findings suggest that the standard account of mortgage foreclosure is missing a large portion of the story. Mortgage foreclosures are not just the results of bad loans, bad properties, or bad borrowers. Instead, many mortgage foreclosures are the result of unpredictable medical disruptions that impact both the incomes and the expenses of family finances.
http://works.bepress.com/cgi/viewcontent.cgi?article=1001&context=christopher_robertson

The authors of this study indicate that the results are only preliminary, primarily due to limitations in methodology. Although we cannot quantify precisely the extent of the problem, the qualitative conclusion is certainly valid. Just as with personal bankruptcy, medical debt in both insured and uninsured individuals contributes to loss of homes through mortgage foreclosures.
This past month has demonstrated to all of us the importance, for our entire economy, of establishing policies that would ensure that default of home mortgages would be a relatively rare event. Eliminating medical debt certainly would not prevent all home loan defaults, but it would prevent a great many of them, even if we cannot yet precisely quantify how many.
Simply changing to a more efficient, single payer national health program would be one of the least expensive measures that we could undertake to help reduce home mortgage foreclosures.
Almost everyone would like to see measures that would reduce the negative impact of our financial crisis that was precipitated by mortgage-bcked securities. Some of us also would like to see that everyone has affordable access to health care, even if it is only an additional benefit of a financial rescue package.

Medical causes of home mortgage foreclosures

Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures

By Christopher Tarver Robertson, Richard Egelhof, & Michael Hoke
Health Matrix
Vol. 18:65 2008

In recent years, there has been national alarm about the rising rate of home foreclosures, which now strike one in every 92 households in America, and which contribute to even broader macroeconomic effects.

These factors — loose lending, irresponsible borrowers, a flat real estate market, and rising interest rates — have together become the “standard account” of home foreclosure.

Policymakers and scholars may be surprised to learn that even in the midst of this spike, one of the largest causes of home foreclosures was none of the above. We studied homeowners going through foreclosure in four states and found that medical crises contribute to half of all home foreclosure filings. If these patterns hold nationwide, medical causes may put as many as 1.5 million Americans in jeopardy of losing their homes each year.

Half of all respondents (49%) indicated that their foreclosure was caused in part by a medical problem, including illness or injuries (32%), unmanageable medical bills (23%), lost work due to a medical problem (27%), or caring for sick family members (14%). We also examined objective indicia of medical disruptions in the previous two years, including those respondents paying more than $2,000 of medical bills out of pocket (37%), those losing two or more weeks of work because of injury or illness (30%), those currently disabled and unable to work (8%), and those who used their home equity to pay medical bills (13%). Altogether, we found that about 7 in 10 of our respondents either self-reported a medical cause of foreclosure, or experienced one of these indicia of medical disruptions in the years before foreclosure.

Altogether, these findings suggest that the standard account of mortgage foreclosure is missing a large portion of the story. Mortgage foreclosures are not just the results of bad loans, bad properties, or bad borrowers. Instead, many mortgage foreclosures are the result of unpredictable medical disruptions that impact both the incomes and the expenses of family finances.

http://works.bepress.com/cgi/viewcontent.cgi?article=1001&context=christopher_robertson

Comment:

By Don McCanne, MD

The authors of this study indicate that the results are only preliminary, primarily due to limitations in methodology. Although we cannot quantify precisely the extent of the problem, the qualitative conclusion is certainly valid. Just as with personal bankruptcy, medical debt in both insured and uninsured individuals contributes to loss of homes through mortgage foreclosures.

This past month has demonstrated to all of us the importance, for our entire economy, of establishing policies that would ensure that default of home mortgages would be a relatively rare event. Eliminating medical debt certainly would not prevent all home loan defaults, but it would prevent a great many of them, even if we cannot yet precisely quantify how many.

Simply changing to a more efficient, single payer national health program would be one of the least expensive measures that we could undertake to help reduce home mortgage foreclosures.

Almost everyone would like to see measures that would reduce the negative impact of our financial crisis that was precipitated by mortgage-bcked securities. Some of us also would like to see that everyone has affordable access to health care, even if it is only an additional benefit of a financial rescue package.

Doctors to candidates: enact single-payer health reform

Embargoed until:
Oct. 6, 2008
5:30 p.m. EDT

Contacts:
Steffie Woolhandler, M.D.
Oliver Fein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Over 5,000 U.S. physicians have signed an open letter calling on the candidates for president and Congress “to stand up for the health of the American people and implement a nonprofit, single-payer national health insurance system.”

Noting that the nation’s private-insurance-based model is failing by denying needed medical care to millions, wasting resources and driving up costs, the doctors say that a publicly financed system is “the sole hope for affordable, comprehensive coverage.”

“A single-payer health system could realize administrative savings of more than $300 billion annually — enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans,” they write, adding that it would also slow cost increases.

Dr. Oliver Fein, a professor of clinical medicine and public health at Weill Cornell Medical College in New York and a signer of the letter, said today, “With the sudden economic downturn, more people than ever before are worried about how to pay for health care. A single-payer system — an improved Medicare for all — would lift those worries, provide care to all who need it and require no new money. It’s the only morally and fiscally responsible approach to take.”

In their letter, the physicians express disappointment that most U.S. political leaders still cling to the private health insurance industry model of financing care and “seem intent on reprising failed schemes from the past” like mandates or tax incentives.

“The incremental changes suggested by most Democrats cannot solve our problems; further pursuit of market-based strategies, as advocated by Republicans, will exacerbate them,” they say. “What needs to be changed is the system itself.”

The letter is being circulated by Physicians for a National Health Program, a single-payer advocacy group. Fein is the group’s president-elect. Excerpts from the appeal are being published in full-page advertisements in the Oct. 13 editions of The New Yorker and The Nation magazines, which arrive on newsstands this week.

Signers of the letter include some of the most prominent figures in U.S. medicine, including leaders of professional societies in internal medicine, pediatrics, family medicine, psychiatry and public health. Among them are Marcia Angell, M.D., senior lecturer at Harvard Medical School and past editor-in-chief of the New England Journal of Medicine, and Bernard Lown, M.D., professor of cardiology emeritus at Harvard and Nobel laureate.

Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and a co-author of the letter, said, “Physicians have a responsibility to get to the root of a patient’s medical complaint, to make a diagnosis based on evidence. Only then can we confidently prescribe a cure, rather than offer a consoling placebo.

“Given the repeated failure of incremental reforms like the one under way in Massachusetts, which is already facing cost overruns and leaving many residents uncovered, and given the increasingly obvious failure of unfettered markets, it’s clear that neither of these traditional prescriptions for reform will work,” she said. “What’s needed instead is the only treatment that has proven its effectiveness — a single-payer plan.”

The letter’s release follows a survey in the Annals of Internal Medicine this spring that shows 59 percent of U.S. physicians support national health insurance, a jump of 10 percentage points from five years ago

Single-payer plans typically involve a single, publicly administered social insurance fund that guarantees health care coverage for everyone, much like Medicare presently does for seniors. Patients go the doctors and hospitals of their choice; health care providers largely remain private. Private health insurers are eliminated or their role is substantially reduced.

A bill in Congress, the U.S. National Health Insurance Act, H.R. 676, embodies the single-payer model. Sponsored by Rep. John Conyers Jr. (D-Mich.), it currently has over 90 co-sponsors, more than any other health reform proposal.

The ads in The New Yorker and The Nation announcing the physicians’ open letter feature Nicole Hollander’s cartoon character Sylvia writing a letter to Congress.

The full text and initiating signers of the “Open Letter to the Candidates on Single Payer Health Reform” are available at www.pnhp.org/letter/.

The complete list of signers is available at www.pnhp.org/letter/signers/.

A PDF of the full-page, four-color ad that is appearing in the pages of The New Yorker and The Nation can be found at www.pnhp.org/ad.

###

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, call (312) 782-6006 or visit www.pnhp.org/stateactions.

The V.P. debate and the agenda for health reform

The Vice-Presidential Debate

October 2, 2008
Sarah Palin: (in her closing statement) It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don’t pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we’re going to find ourselves SPENDING OUR SUNSET YEARS TELLING OUR CHILDREN AND OUR CHILDREN’S CHILDREN ABOUT A TIME IN AMERICA, BACK IN THE DAY, WHEN MEN AND WOMEN WERE FREE.
Video and transcript:
http://elections.nytimes.com/2008/president/debates/vice-presidential-debate.html

And…

Ronald Reagan Speaks Out Against Socialized Medicine LP recording, 1961, Woman’s Auxiliary of the AMA

Ronald Reagan: Write those letters now. Call your friends, and tell them to write them. If you don’t, this program (King-Anderson version of Medicare) I promise you will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade every area of freedom as we have known it in this country, until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this, and if I don’t do it, one of these days, you and I are going to SPEND OUR SUNSET YEARS TELLING OUR CHILDREN, AND OUR CHILDREN’S CHILDREN, WHAT IT WAS ONCE LIKE IN AMERICA WHEN MEN WERE FREE.
WHAM campaign (Women Help American Medicine):
http://www.larrydewitt.net/Essays/Reagan.htm
mp3 audio of “Ronald Reagan Speaks Out Against Socialized Medicine”
http://blogfiles.wfmu.org/KF/reagan1.mp3

If you really care about the future of our health care system, you should give some thought to the motivation of the McCain/Palin camp in selecting this closing statement for her debate.
Obama and Biden support a greater government role in ensuring that more individuals have affordable health care and health care coverage. McCain and Palin support freedom and individual responsibility in accessing health care and health care coverage. If you need health care, well designed public policies can work for all of us, but private policies can work only for those with the financial means to obtain adequate coverage.
For her closing statement, the McCain/Palin advisors selected the most notorious attack on a government role in health care, deceptively cloaked in the rhetoric of freedom. That should tell you something.

The V.P. debate and the agenda for health reform

The Vice-Presidential Debate

October 2, 2008

Sarah Palin: (in her closing statement) It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don’t pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we’re going to find ourselves SPENDING OUR SUNSET YEARS TELLING OUR CHILDREN AND OUR CHILDREN’S CHILDREN ABOUT A TIME IN AMERICA, BACK IN THE DAY, WHEN MEN AND WOMEN WERE FREE.

Video and transcript:
http://elections.nytimes.com/2008/president/debates/vice-presidential-debate.html

And…

Ronald Reagan Speaks Out Against Socialized Medicine LP recording, 1961, Woman’s Auxiliary of the AMA

Ronald Reagan: Write those letters now. Call your friends, and tell them to write them. If you don’t, this program (King-Anderson version of Medicare) I promise you will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade every area of freedom as we have known it in this country, until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this, and if I don’t do it, one of these days, you and I are going to SPEND OUR SUNSET YEARS TELLING OUR CHILDREN, AND OUR CHILDREN’S CHILDREN, WHAT IT WAS ONCE LIKE IN AMERICA WHEN MEN WERE FREE.

WHAM campaign (Women Help American Medicine):
http://www.larrydewitt.net/Essays/Reagan.htm

mp3 audio of “Ronald Reagan Speaks Out Against Socialized Medicine”
http://blogfiles.wfmu.org/KF/reagan1.mp3

Comment:

By Don McCanne, MD

If you really care about the future of our health care system, you should give some thought to the motivation of the McCain/Palin camp in selecting this closing statement for her debate.

Obama and Biden support a greater government role in ensuring that more individuals have affordable health care and health care coverage. McCain and Palin support freedom and individual responsibility in accessing health care and health care coverage. If you need health care, well designed public policies can work for all of us, but private policies can work only for those with the financial means to obtain adequate coverage.

For her closing statement, the McCain/Palin advisors selected the most notorious attack on a government role in health care, deceptively cloaked in the rhetoric of freedom. That should tell you something.

Commonwealth Fund on candidates' proposals

The 2008 Presidential Candidates’ Health Reform Proposals: Choices for America

By Sara R. Collins, Jennifer L. Nicholson, Sheila D. Rustgi, and Karen Davis
The Commonwealth Fund
October 2008
The presidential candidates’ health care reform proposals offer fundamentally different visions of the future of health insurance in the United States. Both candidates propose reforms in which the health system would continue to be structured around private insurance markets, with a supporting role played by public insurance programs. But their plans diverge significantly on the way a reformed system should operate.
McCain would change the tax code to encourage people to buy coverage through the individual insurance market and effectively loosen state rules governing the sale of insurance by allowing people to buy policies across state lines. Obama would encourage the continuing participation of employers in the health insurance system, expand eligibility for Medicaid and the State Children’s Health Insurance Program (SCHIP), and create a new insurance market “exchange” — with consumer protections, choice of public and private health plans, and income-based premium subsidies — that would largely replace the individual market.
According to one estimate… in 10 years McCain’s proposal would reduce the number of people who are uninsured by 2 million out of a projected 67 million. Obama’s plan would reduce the number of uninsured people by 34 million in 10 years.
Executive Summary:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=707948
Full Report:
http://www.commonwealthfund.org/usr_doc/Collins_presidentialcandhltreformprop_1179.pdf?section=4039

So these are the “choices for America.” We currently have 46 million people who are uninsured. After ten years of McCain’s plan, we would have 65 million uninsured, but ten years of Obama’s plan would leave only 33 million people without insurance. Only 33 million!?
The phrase, “both candidates propose reforms in which the health system would continue to be structured around private insurance markets,” should set off deafening alarm bells and sirens. Schemes designed around U.S.-style private insurance markets can never achieve our goal of affordable health care for everyone.
Some say that we could do it if we required everyone to participate through individual and employer mandates. With an average family policy now priced at $12,600, not including deductibles and copayments, it is unrealistic to require individuals and small businesses to purchase coverage and health care with money that they do not have. Even Sen. McCain understands that the government is going to have to ante up, but that alone is still not enough since his proposal would leave 65 million uninsured.
With a national health expenditure of $2.4 trillion, we already have enough to fund a universal risk pool that would pay for all necessary services for absolutely everyone, but only if we were to do it through a single payer national health program. If we were to attempt it using private plans that were truly effective in preventing financial hardship, and that had government subsidies that would make the premiums affordable, the inefficiencies would add close to half a trillion dollars to our national health care bill, and too many individuals would still fall through the cracks.
So what about choices for America? Which candidate? Or which health reform proposal?
In a September 30 interview with the Des Moines Register editorial board, Sen. McCain provides us with some insight to these choices: “I’ve always been a free enterprise person who thinks that families make the best choices for themselves and their future. That’s a dramatically different philosophy than my Democrat friends, in my view, who think that government is the answer. Sen. Obama wants to create a huge health care bureaucracy for America.”
Sen. Obama has said that, if starting from scratch, we would create a single payer system. That’s the health reform proposal that Americans should choose if we’re really serious about including absolutely everyone in an affordable program. And which candidate do you think would approve this message?
Video of Sen. McCain’s Des Moines Register interview:
http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20080930/NEWS09/80930049