PNHP

Maximum coverage as defined by Anthem Blue Cross

Maximum coverage as defined by Anthem Blue Cross

Letter
From: Anthem Blue Cross, Oxnard, California
To: Don McCanne

Dear Don,

Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. …

http://www.anthem.com/

Comment:

By Don McCanne, MD

What’s this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system.

The three page questionnaire enclosed with the letter asks for extensive detailed information on matters such as employer, number of fellow employees, insurance company, group number, member/plan ID, Rx PCN, Rx Bin, Person Code, etc. The same questions are asked about the spouse’s employer and coverage as well. There are detailed questions about other supplemental drug coverage, about Coal Miner’s Medical Benefits, and about coverage under no-fault or automobile insurance. There is a detailed question about present or pending Workers’ Compensation claims, including the name and address of your attorney. There is another question about any illness or injury for which another party could be held liable, also including a request for the name and address of your attorney.

A quote from the forty-two page booklet on our Blue Cross of California Part D coverage (now Anthem Blue Cross): “… the prescription drug coverage you get from us will be secondary to your employer or retiree group coverage.”

This is not a process that would afford Anthem Blue Cross the opportunity to increase payment for any prescription drugs that qualify. Assuring that you receive the “maximum coverage benefits” refers to the maximum that will be paid after excluding the legitimate claims that they would shift to other potential payers. Under these circumstances, the maximum benefit frequently would be no benefit payment at all.

There could not be a more clear distinction between the business model of private health plans in the United States, and the social insurance models of private health plans used in other countries. Private plans unified in a social insurance program assist patients in paying for the care they need. Our private insurers, such as Anthem Blue Cross, use every devious method they can to avoid paying for the care that patients need. And they add more wasteful administrative complexity to the health care financing process, made even worse by the fragmentation of the financing system.

If we were to adopt a financing system using private insurers that would provide adequate affordable coverage for everyone, then we would have to totally transform the private insurance industry into a social insurance model. For that transformation to be equitable and effective, those who do not want to give up the coverage they have would have to acknowledge that their plan would be transformed anyway to comply with requirements for universal risk pooling, guaranteed issue, prevention of adverse selection, adequate benefit package, elimination of under-insurance, and other measures that define social insurance programs.

That transformation would be both politically and administratively more difficult and more expensive than replacing private insurers with a more efficient and effective single payer national health program. Besides, why do we insist on continuing to protect an industry that thrives by cheating us out of our health care benefits?

Health care cost increases continue to plague employers

Employers Face 10.6 Percent Health Care Cost Increases, Says Aon Consulting

Aon
August 12, 2008
Health care costs are expected to increase on average 10.6 percent in the next 12 months, according to Aon Consulting Worldwide, the global human capital consulting organization of Aon Corporation.
Aon Consulting surveyed more than 70 leading health care insurers, representing more than 100 million insured individuals, and found that health care costs are projected to increase by 10.6 percent for HMOs, 10.5 percent for POS plans, 10.7 percent for PPOs and 10.5 percent for CDH plans. These represent the lowest trend rate increases since the study began in 2001.
http://aon.mediaroom.com/index.php?s=43&item=1285

And…

PwC Health and Wellness Touchstone Survey Results

PricewaterhouseCoopers
June, 2008
561 companies across the United States responded to the survey.
Self-insurance is the primary funding mechanism for respondent companies.
Over 65% of survey participants said that their medical plan cost increases for 2007 over 2006 and 2008 over 2007 (before plan design changes) will be in excess of 5%.
– Over 30% believe increases will be over 10%
– Over 7% believe increases will be over 15%
(A bar graph indicates that the ’07/’08 average trend is about 7.4% for companies with less than 5000 employees, and 6.0% for those with greater than 5000 employees.)
Future Solutions: Cost Shifting
– 41% of survey participants plan to increase employee contributions over the next two years
– 38% of survey participants plan to increase medical plan cost sharing through plan design changes over the next two years
http://www.pwc.com/extweb/pwcpublications.nsf/docid/574877A4F50E390285257483005250AE?OpenDocument

The health care cost data from these two consulting firms are important because they represent the increases in the costs of employer-sponsored coverage – the Aon survey representing the costs of private health insurance plans, and the PricewaterhouseCoopers survey representing the costs for self-insured employers. A few conclusions can be drawn from these surveys.

  • Although reports of the Aon survey celebrated the “lowest trend rate increases since the study began in 2001,” the increases continue to be far in excess of the rate of inflation. The mainstay of health care coverage for the majority of us – employer-sponsored plans – is becoming ever less affordable. Private insurers and self-insured employers have not been able to moderate this trend.
  • The increases for self-insured employers are not as great as for employers that depend on private health insurance plans. This is further evidence that the private insurers have fallen far short of their claims that they have been effective in controlling health care costs. The opposite is true. The waste of their administrative excesses is placing a greater financial burden on the purchasers of their plans.
  • Although the increases for the self-insured are not as great, they still demonstrate that employers themselves have not been successful in harnessing the excessive costs in health care.
  • The Aon survey demonstrates that the rates for consumer-directed plans (CDH) continue to increase as much as the other models of private insurance plans. CDH plans are not a solution for rising health care costs.
  • Employers are continuing to seek relief by shifting more of the costs to their employees through greater employee contributions and innovative plan designs that will only compound the rapidly growing problem of under-insurance.

Employers control health care coverage for close to 60 percent of us. In spite of this buying power, they have been unable to control cost increases. The private insurers have only made the problem worse. We do understand where much of the waste is occurring (administrative excesses, detrimental high-tech excesses, inappropriate pricing, lack of an adequate primary care infrastructure, etc.), but we haven’t established an effective financing system that would address these cost and quality problems.
The solution is simple. We merely need to combine all health care funds into a single national health program. The monopsony that would be created (a single buyer of health care services) would have the market power to reduce the waste while realigning incentives to provide us with affordable access to a high quality health care delivery system. Monopsonies in the private sector can be quite nefarious, but our own beneficent public monopsony would serve us all well.

Health care cost increases continue to plague employers

Employers Face 10.6 Percent Health Care Cost Increases, Says Aon Consulting

Aon
August 12, 2008

Health care costs are expected to increase on average 10.6 percent in the next 12 months, according to Aon Consulting Worldwide, the global human capital consulting organization of Aon Corporation.

Aon Consulting surveyed more than 70 leading health care insurers, representing more than 100 million insured individuals, and found that health care costs are projected to increase by 10.6 percent for HMOs, 10.5 percent for POS plans, 10.7 percent for PPOs and 10.5 percent for CDH plans. These represent the lowest trend rate increases since the study began in 2001.

http://aon.mediaroom.com/index.php?s=43&item=1285

And…

PwC Health and Wellness Touchstone Survey Results

PricewaterhouseCoopers
June, 2008

561 companies across the United States responded to the survey.

Self-insurance is the primary funding mechanism for respondent companies.

Over 65% of survey participants said that their medical plan cost increases for 2007 over 2006 and 2008 over 2007 (before plan design changes) will be in excess of 5%.
— Over 30% believe increases will be over 10%
— Over 7% believe increases will be over 15%
(A bar graph indicates that the ’07/’08 average trend is about 7.4% for companies with less than 5000 employees, and 6.0% for those with greater than 5000 employees.)

Future Solutions: Cost Shifting

— 41% of survey participants plan to increase employee contributions over the next two years
— 38% of survey participants plan to increase medical plan cost sharing through plan design changes over the next two years

http://www.pwc.com/extweb/pwcpublications.nsf/docid/574877A4F50E390285257483005250AE?OpenDocument

Comment:

By Don McCanne, MD

The health care cost data from these two consulting firms are important because they represent the increases in the costs of employer-sponsored coverage – the Aon survey representing the costs of private health insurance plans, and the PricewaterhouseCoopers survey representing the costs for self-insured employers. A few conclusions can be drawn from these surveys.

* Although reports of the Aon survey celebrated the “lowest trend rate increases since the study began in 2001,” the increases continue to be far in excess of the rate of inflation. The mainstay of health care coverage for the majority of us – employer-sponsored plans – is becoming ever less affordable. Private insurers and self-insured employers have not been able to moderate this trend.

* The increases for self-insured employers are not as great as for employers that depend on private health insurance plans. This is further evidence that the private insurers have fallen far short of their claims that they have been effective in controlling health care costs. The opposite is true. The waste of their administrative excesses is placing a greater financial burden on the purchasers of their plans.

* Although the increases for the self-insured are not as great, they still demonstrate that employers themselves have not been successful in harnessing the excessive costs in health care.

* The Aon survey demonstrates that the rates for consumer-directed plans (CDH) continue to increase as much as the other models of private insurance plans. CDH plans are not a solution for rising health care costs.

* Employers are continuing to seek relief by shifting more of the costs to their employees through greater employee contributions and innovative plan designs that will only compound the rapidly growing problem of under-insurance.

Employers control health care coverage for close to 60 percent of us. In spite of this buying power, they have been unable to control cost increases. The private insurers have only made the problem worse. We do understand where much of the waste is occurring (administrative excesses, detrimental high-tech excesses, inappropriate pricing, lack of an adequate primary care infrastructure, etc.), but we haven’t established an effective financing system that would address these cost and quality problems.

The solution is simple. We merely need to combine all health care funds into a single national health program. The monopsony that would be created (a single buyer of health care services) would have the market power to reduce the waste while realigning incentives to provide us with affordable access to a high quality health care delivery system. Monopsonies in the private sector can be quite nefarious, but our own beneficent public monopsony would serve us all well.

Doctor says U.S. needs universal health care

Birmingham physician touts bill to expand Medicare

By STEVE DOYLE
Huntsville Times
Thursday, August 14, 2008

Dr. Wally Retan knows the odds aren’t great that Congress will pass a universal health care bill anytime soon.

But the chairman of Alabama’s “Health Care for Everyone” chapter still dreams of a time when all Americans have comprehensive, low-cost health insurance provided by the federal government.

The semi-retired Birmingham physician spent Wednesday in Huntsville trying to rally public support for a controversial bill he says would accomplish that goal. Sponsored by U.S. Rep. John Conyers, D-Mich., it would expand Medicare-type coverage to everyone.

“The status quo is no longer acceptable; we’ve got to do something,” Retan told about 30 members of the city’s Peace and Democracy group at Fern Bell Recreation Center.

He said Conyers’ proposed “National Health Insurance Act” is backed by 92 other members of Congress (none from Alabama), two Nobel laureates, three former U.S. surgeons general and the 16,000-member Physicians for a National Health Care Program.

Retan, who gave a second talk Wednesday night at Crestwood Medical Center, said annual health care spending in the United States exploded from about $28 billion in 1960 to $2.8 trillion today. That’s about $6,000 for every man, woman and child.

The U.S. Census Bureau estimates 47 million people have no health insurance, and Retan said another 20 percent of the population is underinsured.

“They have what I call miniskirt insurance,” he said. “It looks good, but it doesn’t cover very much.”

Medical costs have skyrocketed so much that Starbucks now spends more on employee health care than coffee beans, said Retan, 77.

He said Conyers’ bill would rein in medical spending by shoving aside private insurance companies, whose “handsome executive salaries” contribute to their high administrative costs.

Most of the world’s industrialized nations and a few others, including Thailand, have found a way to provide universal health care, Retan said.

“What’s going to happen with all of this nobody knows, but it’s going to be interesting to find out,” he said. “Once in a while, the impossible happens.”

Retan’s talk inspired a lively debate among Peace and Democracy group members. Noor Gillani said America has the economic ability to provide universal health coverage, but people are going to have to demand it.

“If people become educated and know the truth,” Gillani said, “they’re going to fight for it.”

http://www.al.com/news/huntsvilletimes/index.ssf?/base/news/1218705432306300.xml&coll=1

Here's your chance to tell MoveOn either lead or get out of the way

by nyceve
DailyKos
Wed Aug 13, 2008

This morning a variety of single-payer healthcare advocacy organizations including Progressive Democrats of America, Healthcare Now, PNHP and All Unions Committee For Single Payer Health Care are petitioning MoveOn.

I’ve been asked to explain to Daily Kos readers what’s happening and ask you to support single-payer healthcare in the United States by signing the petition to MoveOn.

Here’s a link to the MoveOn petition we hope you will sign.

The Background.

You may remember that our friends at MoveOn lent their esteemed reputation to our friends at Health Care for America Now.

Healthcare for America Now “is a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all.” HCAN by its own words, would maintain the private health insurance industry.

“We’re offering a bold new solution that gives you real choice and a guarantee of quality coverage you can afford: keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.

We’re also calling for regulation on health insurance companies. We need to set and enforce rules that quash health insurance companies’ greed once and for all.”

Their solution is neither bold nor new.

Before I go any further, allow me to make it clear again, both MoveOn and Healthcare for America Now are our friends, but occasionally even friends need a swift kick in the butt.

We’d like your help in a very straightforward undertaking.

We’re asking for one or two minutes of your time and your signature on a petition which will be delivered to MoveOn.

We hope with enough signatures, MoveOn may re-think its position vis a vis HCAN. If enough people express disappointment with MoveOn, perhaps it will consider using its enormous influence to encourage HCAN to propose a genuine single payer option as part of its huge multi-million dollar advertising campaign. This would be an enormous victory.

Here’s a link to the petition which will be presented to MoveOn.

Why are we taking this action?

Because MoveOn and Healthcare for America Now are pursuing a misguided strategy. I would say it is something akin to a policy of appeasement with the health insurance industry.

And it won’t work. All these good organizations should have the brains to know this.

Because we have one more chance to get it right.

Because you don’t wave the white flag of surrender before the fight has even begun.

Because with single-payer healthcare you choose your doctor, you choose your hospital, you have complete freedom of choice. The healthcare delivery system stays the same. There is only one difference, you cut out the parasitic and worthless middleman and replace this entity with a government payer. The precious healthcare dollars are spent on healthcare not insurer profits.

If you need more convincing, please keep reading.

The dirty deeds of for-profit insurance companies litter the landscape and touch all American families at their most desperate and vulnerable moments. Oversight (the HCAN solution)–the proverbial slap on the wrist–won’t change the culture of greed. The U.S. health insurance industry has a long and horrific track record–they are merciless predators.

You don’t bargain with criminals AHIP. You throw them in jail, then you throw away the key.

If you agree that MoveOn made a unilateral, hence undemocratic decision to align itself with Healthcare for America Now.

If you agree that Healthcare for America Now should at bare minimum, place a single-payer option on its agenda and in its advertising.

If you agree that MoveOn should have encouraged an open debate, and asked its 3.2 million members and supporters whether we support the HCAN solution or single payer healthcare, then please sign the petition.

Please take a minute to sign the petition.

Why we fight.

These are the eloquent words of Rose Ann DeMoro, the executive director of the California Nurses Association, explaining why HCAN is way off the mark.

You can read the full text here.

Why is Health Care for America Now giving up on real reform?

But, in search of a supposedly politically viable plan, the advocates of this approach have surrendered in advance on the only overhaul that will actually cure the disease, a single-payer, expanded and improved Medicare for all reform.

Their good intentions will leave the same failed system in place, and will not even blunt the political opposition from those on the right and corporate interests who will continue to challenge anything that looks like even modest reform.

. . .There’s just one problem — the coalition’s proposal does nothing to end the actual practice of insurance companies putting their profits ahead of your health. Nor does it fix the two central components of the health care morass — insurance company denials of care and the financial squeeze facing American families due to ever skyrocketing healthcare costs which is exacerbated by the escalating credit crisis.

. . .How does the HCFAN coalition propose to crack down on the insurance pirates? With a “watchdog role” on the plans “to assure that risk is fairly spread” and that “insurers do not turn people away, raise rates or drop coverage based on a person’s health history or wrongly delay or deny care.”

You can watch someone rob your bank, but unless you stop them, the vaults are still going to be stripped bare. If you’re looking for the hammer or any enforcement mechanism in the HCFAN proposal, don’t bother, it’s not there.

Now on to the petition, you can and should read the entire petition at the link.

WE, THE UNDERSIGNED, respectfully petition the leaders of MoveOn.Org to abide by its core democratic principles and ask the opinion of its members whether they support reform of the private health insurance system or replacement of private health insurance by universal single payer health care, before MoveOn continues to organizationally and financially support a new coalition which supports the former and excludes the latter.

And just so everyone understands what single payer is all about, I’d like you to read a piece of an editorial which was in the center right Seattle Times.

Vital signs for national health insurance

Single-payer health insurance is about who pays the bills, not who provides the medical care. Instead of having private insurance, everyone pays into a common fund. Nothing about the health-care-delivery system changes.

No one is employed by the government except the people who write the checks. Call it Medicare for everyone. Instead of waiting until age 65 for decent medical care, everyone — everyone — has access to a doctor.

The public’s interest in guaranteed health insurance has been picking up in polls, but a significant change was reported this spring in the Annals of Internal Medicine, a leading medical journal. A study found 59 percent of U.S. physicians now support national health insurance, a jump of 10 percentage points in five years.

Support for national health insurance — private doctors paid by a federally administered plan — has gained support across medical specialties, according to Dr. Aaron E. Carroll, of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine in Indianapolis.

Doctors have layers of frustrations with the current system of private insurers, Carroll said in a telephone conversation this week. Serving on the front lines of the medical system, they see the toll on patients without insurance and on the underinsured.

. . .So far, the presidential candidates are behind the curve on health-care reform. Dr. John P. Geyman, professor emeritus of family medicine at the University of Washington, laments that Republican John McCain offers no new ideas and Democrat Barack Obama’s incremental approach falls short of a fix.

http://seattletimes.nwsource.com/

Today we add MoveOn and Healthcare for America Now to the list of those hopelessly behind the curve.

Please take a minute to sign the petition.

Here’s your chance to tell MoveOn either lead or get out of the way

by nyceve
DailyKos
Wed Aug 13, 2008

This morning a variety of single-payer healthcare advocacy organizations including Progressive Democrats of America, Healthcare Now, PNHP and All Unions Committee For Single Payer Health Care are petitioning MoveOn.

I’ve been asked to explain to Daily Kos readers what’s happening and ask you to support single-payer healthcare in the United States by signing the petition to MoveOn.

Here’s a link to the MoveOn petition we hope you will sign.

The Background.

You may remember that our friends at MoveOn lent their esteemed reputation to our friends at Health Care for America Now.

Healthcare for America Now “is a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all.” HCAN by its own words, would maintain the private health insurance industry.

“We’re offering a bold new solution that gives you real choice and a guarantee of quality coverage you can afford: keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.

We’re also calling for regulation on health insurance companies. We need to set and enforce rules that quash health insurance companies’ greed once and for all.”

Their solution is neither bold nor new.

Before I go any further, allow me to make it clear again, both MoveOn and Healthcare for America Now are our friends, but occasionally even friends need a swift kick in the butt.

We’d like your help in a very straightforward undertaking.

We’re asking for one or two minutes of your time and your signature on a petition which will be delivered to MoveOn.

We hope with enough signatures, MoveOn may re-think its position vis a vis HCAN. If enough people express disappointment with MoveOn, perhaps it will consider using its enormous influence to encourage HCAN to propose a genuine single payer option as part of its huge multi-million dollar advertising campaign. This would be an enormous victory.

Here’s a link to the petition which will be presented to MoveOn.

Why are we taking this action?

Because MoveOn and Healthcare for America Now are pursuing a misguided strategy. I would say it is something akin to a policy of appeasement with the health insurance industry.

And it won’t work. All these good organizations should have the brains to know this.

Because we have one more chance to get it right.

Because you don’t wave the white flag of surrender before the fight has even begun.

Because with single-payer healthcare you choose your doctor, you choose your hospital, you have complete freedom of choice. The healthcare delivery system stays the same. There is only one difference, you cut out the parasitic and worthless middleman and replace this entity with a government payer. The precious healthcare dollars are spent on healthcare not insurer profits.

If you need more convincing, please keep reading.

The dirty deeds of for-profit insurance companies litter the landscape and touch all American families at their most desperate and vulnerable moments. Oversight (the HCAN solution)–the proverbial slap on the wrist–won’t change the culture of greed. The U.S. health insurance industry has a long and horrific track record–they are merciless predators.

You don’t bargain with criminals AHIP. You throw them in jail, then you throw away the key.

If you agree that MoveOn made a unilateral, hence undemocratic decision to align itself with Healthcare for America Now.

If you agree that Healthcare for America Now should at bare minimum, place a single-payer option on its agenda and in its advertising.

If you agree that MoveOn should have encouraged an open debate, and asked its 3.2 million members and supporters whether we support the HCAN solution or single payer healthcare, then please sign the petition.

Please take a minute to sign the petition.

Why we fight.

These are the eloquent words of Rose Ann DeMoro, the executive director of the California Nurses Association, explaining why HCAN is way off the mark.

You can read the full text here.

Why is Health Care for America Now giving up on real reform?

But, in search of a supposedly politically viable plan, the advocates of this approach have surrendered in advance on the only overhaul that will actually cure the disease, a single-payer, expanded and improved Medicare for all reform.

Their good intentions will leave the same failed system in place, and will not even blunt the political opposition from those on the right and corporate interests who will continue to challenge anything that looks like even modest reform.

. . .There’s just one problem — the coalition’s proposal does nothing to end the actual practice of insurance companies putting their profits ahead of your health. Nor does it fix the two central components of the health care morass — insurance company denials of care and the financial squeeze facing American families due to ever skyrocketing healthcare costs which is exacerbated by the escalating credit crisis.

. . .How does the HCFAN coalition propose to crack down on the insurance pirates? With a “watchdog role” on the plans “to assure that risk is fairly spread” and that “insurers do not turn people away, raise rates or drop coverage based on a person’s health history or wrongly delay or deny care.”

You can watch someone rob your bank, but unless you stop them, the vaults are still going to be stripped bare. If you’re looking for the hammer or any enforcement mechanism in the HCFAN proposal, don’t bother, it’s not there.

Now on to the petition, you can and should read the entire petition at the link.

WE, THE UNDERSIGNED, respectfully petition the leaders of MoveOn.Org to abide by its core democratic principles and ask the opinion of its members whether they support reform of the private health insurance system or replacement of private health insurance by universal single payer health care, before MoveOn continues to organizationally and financially support a new coalition which supports the former and excludes the latter.

And just so everyone understands what single payer is all about, I’d like you to read a piece of an editorial which was in the center right Seattle Times.

Vital signs for national health insurance

Single-payer health insurance is about who pays the bills, not who provides the medical care. Instead of having private insurance, everyone pays into a common fund. Nothing about the health-care-delivery system changes.

No one is employed by the government except the people who write the checks. Call it Medicare for everyone. Instead of waiting until age 65 for decent medical care, everyone — everyone — has access to a doctor.

The public’s interest in guaranteed health insurance has been picking up in polls, but a significant change was reported this spring in the Annals of Internal Medicine, a leading medical journal. A study found 59 percent of U.S. physicians now support national health insurance, a jump of 10 percentage points in five years.

Support for national health insurance — private doctors paid by a federally administered plan — has gained support across medical specialties, according to Dr. Aaron E. Carroll, of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine in Indianapolis.

Doctors have layers of frustrations with the current system of private insurers, Carroll said in a telephone conversation this week. Serving on the front lines of the medical system, they see the toll on patients without insurance and on the underinsured.

. . .So far, the presidential candidates are behind the curve on health-care reform. Dr. John P. Geyman, professor emeritus of family medicine at the University of Washington, laments that Republican John McCain offers no new ideas and Democrat Barack Obama’s incremental approach falls short of a fix.

http://seattletimes.nwsource.com/

Today we add MoveOn and Healthcare for America Now to the list of those hopelessly behind the curve.

Please take a minute to sign the petition.

Only national insurance can fix broken system

Letter to the Editor
Kennebec (Maine) Journal
08/12/2008

More than 11 million of America’s 47 million uninsured have chronic physical illnesses like heart disease, diabetes and asthma and are not getting the life-saving medical care they need.

According to a recent article in Annals of Internal Medicine, a leading medical journal, uninsured adults with chronic illnesses were nearly four times more likely than the insured to have not seen a health professional within the past year (22 percent vs. 6 percent). They were also six times more likely to identify an emergency room as their standard site for care (7.1 percent vs 1.1 percent).

“We have made dramatic advances in treatment of chronic illnesses like heart disease and high blood pressure,” said Dr. Andrew Wilper, the study’s lead author. “But many Americans are locked out of the system because they are uninsured and cannot afford this life-saving care. Many end up with preventable ER visits, hospitalizations, amputations, kidney failure or worse because their chronic condition has gotten out of control,” he said.

Some claim that uninsured Americans can get the care they need in emergency rooms. But ERs may provide too little, too late for the millions of uninsured with chronic conditions. They need regular medical monitoring and medications to control their illnesses and a whole array of services they cannot afford.

Our profit-driven health care system leaves tens of millions vulnerable. Only single-payer national health insurance can fix this broken system and save thousands of lives each year.

Dr. John Benziger
South China

Copy Massachusetts' health reform? Not so fast, researchers say

For full text of the study: https://pnhp.org/states_flatline/

FOR IMMEDIATE RELEASE
Aug. 11, 2008

Contacts:
David Himmelstein, M.D., (312) 782-6006
Benjamin Day, (617) 777-3422, director@masscare.org
Mark Almberg, (312) 782-6006, mark@pnhp.org

Citing the failure of seven state-based health reforms over the past two decades – initiatives that bear a strong resemblance to the Massachusetts health reform of 2006 – a group of Massachusetts-based researchers cautions that early declarations of the latter’s success may be premature.

In an article titled “State Heath Reform Flatlines,” published in the most recent issue of the International Journal of Health Services, three researchers, two of whom teach at Harvard Medical School, examine the experiences of earlier reforms in Massachusetts, Oregon, Minnesota, Tennessee, Vermont, Washington state and Maine. The plans were enacted from 1988 through 2003.

All seven reforms, which when launched were widely trumpeted by political leaders and leading newspapers as breakthroughs in providing universal health care, were based on the expansion of private insurance coverage, the authors say. But in each case the plan had little impact on the state’s number of uninsured persons and produced no sustained improvements in delivering care.

Dr. David Himmelstein, a co-author of the study, said the 2006 Massachusetts reform appears poised to follow the pattern of the 1992 Tennessee plan, which featured a large expansion of coverage under a Medicaid-like program. “In Tennessee, the number of uninsured dipped for two years, then rose to levels higher than ever,” he said. “And the plan proved to be unaffordable in the long term.

“According to the latest figures on Massachusetts from the National Health Interview Survey,” he continued, “the uninsurance rate has fallen by only 2 percent, from 7.7 percent to 5.8 percent, since the reform was passed, while the plan is already $147 million over budget.”

Himmelstein, who is an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., said the seven failed plans incorporated virtually all of the reform elements being advanced today by leading Democrats, including Sen. Barack Obama. The problem, he said, is that such reforms leave the private health insurance industry in a dominant position.

“Politicians like to claim they’ve passed bold health reforms, but they’re afraid to rock the private insurance boat,” he said. “So they keep pushing gussied-up versions of reforms that have failed time after time. Our health care system is sick to death, and our politicians keep prescribing placebos.”

The authors note that all of the failed plans included expansions of Medicaid or similar programs for the poor and near-poor. Three states’ reforms (Massachusetts in 1988, Oregon in 1989-1992 and Washington state in 1993) included mandates requiring employers to cover their workers, and the Massachusetts and Washington plans also included an individual mandate on the self-employed.

The authors analyzed Census Bureau data on uninsurance rates in each of the seven states. Massachusetts’ uninsurance rate rose from 7.2 percent to 9.7 percent in the three years after the passage of then-governor Michael Dukakis’ universal health care reform in 1988. Uninsurance went from 14.1 percent to 14.7 percent in the three years after implementation of Oregon’s universal health care reform in 1993. The percentage of residents lacking coverage in Washington state increased from 10.7 percent to 11.6 percent in the three years after passage of its universal health care initiative.

Similar patterns occurred in Vermont and Maine. Tennessee’s program (which included the largest Medicaid expansion) was probably the most successful, dropping the share of uninsured in the state from 12 percent to 9 percent in its first year, before a rebound to 14 percent by year three. (See charts in links below.)

All of the plans eventually “flatlined,” or died quiet deaths, the authors said.

According to Benjamin Day, executive director of Mass-Care, a health care advocacy coalition based in Boston, “It’s easy to build political consensus for expanded health coverage. But experience shows that you can’t achieve universal coverage at an affordable price unless you throw out the insurance companies with their massive overhead and profit, and replace them with a more efficient single-payer national health insurance program.

“Senator Obama should learn this lesson,” Day said. As for Sen. John McCain’s health care proposals, “they are so obviously unworkable that it’s hard to take them seriously.”

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The text of the study is available in PDF to the press at www.pnhp.org/states_flatline

Additional charts in PowerPoint format are available at www.pnhp.org/five_states

“State Health Reform Flatlines,” Steffie Woolhandler, MD, MPH; Benjamin Day; and David U. Himmelstein, MD. International Journal of Health Services, Vol. 38, No. 3.

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, visit www.pnhp.org/stateactions or call (312) 782-6006.

Vital signs for national health insurance

By Lance Dickie
Editorial Columnist
Seattle Times
Friday, Aug. 8, 2008

Headlines about job losses and a slumping economy sharpen interest in universal health-insurance coverage.

Searing headlines about local job cuts sharpen interest in universal health-insurance coverage. The topic grabs the attention of those vulnerable families and voters broadly defined as the middle class, the engine of change.

Increasingly, the focus is on national single-payer health insurance. Acceptance of the concept is growing, especially among a key constituency: doctors.

Two years ago, I opined the health-care system was not yet bad enough for real change to occur. The economy was propped up by easy credit and the soon-to-be-exposed liar loans of a fraudulent housing boom. The link between having a job and access to medical care was still secure for so many.

Well, yes, the number of Americans without health insurance was estimated at 47 million — a staggering figure — but the topic and threat seemed comfortably distant from most households.

At the same time, coverage was eroding for many wage earners. Benefits were being cut, insurance exclusions were mounting, co-payments and deductibles were climbing, and children of the middle class were entering a stark economy where employers can no longer afford to offer coverage.

Single-payer health insurance is about who pays the bills, not who provides the medical care. Instead of having private insurance, everyone pays into a common fund. Nothing about the health-care-delivery system changes.

No one is employed by the government except the people who write the checks. Call it Medicare for everyone. Instead of waiting until age 65 for decent medical care, everyone — everyone — has access to a doctor.

The public’s interest in guaranteed health insurance has been picking up in polls, but a significant change was reported this spring in the Annals of Internal Medicine, a leading medical journal. A study found 59 percent of U.S. physicians now support national health insurance, a jump of 10 percentage points in five years.

Support for national health insurance — private doctors paid by a federally administered plan — has gained support across medical specialties, according to Dr. Aaron E. Carroll, of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine in Indianapolis.

Doctors have layers of frustrations with the current system of private insurers, Carroll said in a telephone conversation this week. Serving on the front lines of the medical system, they see the toll on patients without insurance and on the underinsured.

For all the grousing about reimbursement rates paid by Medicare, Carroll said doctors work within an operating model that is easier to navigate, and with vastly lower overhead expenses than hundreds of private insurers. Doctors are fed up with the hassles and billing refusals by different people at different companies with different procedures.

Carroll even sees a national single-payer health-insurance plan offering relief for such knotty problems as malpractice insurance. Most of the legal battles focus on the cost of future health care after a bad outcome. Universal coverage resolves that issue. That leaves a much smaller pool of cases where the fight is over punitive payments for true negligence.

The professional and political mosaic of a national single-payer health system is taking shape. In January, the American College of Physicians endorsed single payer as a pathway to universal coverage. In June, the U.S. Conference of Mayors adopted a resolution in support of HR 676, the United States National Health Insurance Act. Rep. Jim McDermott, D-Seattle, is an articulate proponent of the legislation.

So far, the presidential candidates are behind the curve on health-care reform. Dr. John P. Geyman, professor emeritus of family medicine at the University of Washington, laments that Republican John McCain offers no new ideas and Democrat Barack Obama’s incremental approach falls short of a fix.

Geyman argues the inefficiencies and high overhead of the current health-care system have led to under-use of essential care for vulnerable populations, and a significant amount of unnecessary and inappropriate care for those who can pay for it.

Change is coming. McCain and Obama owe voters a coherent health plan. Their future employment depends on it.

Lance Dickie’s column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com; for a podcast Q&A with the author, go to www.seattletimes.com/edcetera

Copyright (c) 2008 The Seattle Times Company

The Polling Is Quite Clear

The American Public Supports Guaranteed Healthcare on the “Medicare for All” or “Single-Payer” Model

Click here to download the flyer from California Nurses Association / National Nurses Organizing Committee

City of Austin backs 'single-payer' health plan

For Immediate Release:
August 7, 2008

Contacts:
Bill Holloway, Health Care for All Texas (HCFAT), (512) 744-7487, bill.holloway@gmail.com
Ana Malinow, M.D., Physicians for a National Health Program and HCFAT, amalinow@bcm.tmc.edu
Mark Almberg, (312) 782-6006, mark@pnhp.org

AUSTIN, Texas – Affirming that “every person deserves access to affordable, quality health care” and noting that area residents are not getting it, the Austin City Council called today for the enactment of a nonprofit, single-payer national health insurance program.

At its regular Thursday meeting, the Council voted to endorse the U.S. National Health Insurance Act, H.R. 676, sponsored by Rep. John Conyers, D-Mich., and 91 other members of Congress. The vote was six in favor and one abstention.

In taking the action, Austin joined at least 24 other municipalities, including Baltimore, Boston, Chicago, Detroit, San Francisco and Louisville, Ky., that have called for the bill’s passage.

Also known as the Expanded and Improved Medicare for All Act, Conyers’ bill would guarantee everyone access to all medically necessary care, including prescription drugs, with no co-pays or deductibles. It would contain costs by eliminating the administrative waste and bureaucracy associated with the private insurance industry, and it would assure patients their personal choice of doctor and hospital.

Speaking to a local reporter shortly before the vote, Council Member Lee Leffingwell, a co-sponsor of the resolution, said, “This is not socialized medicine. It is basically the same system we have now in the form of Medicare, just more broadly applied.”

Leffingwell told KLBJ-AM radio he was reluctant to get involved in national issues, “but … about 20 percent of our residents don’t have health insurance, and that puts a heavy burden on our area hospitals and our network of social service providers.” Council Members Mike Martinez and Randi Shade joined him in co-sponsoring the measure.

The Council’s action follows on the heels of a similar endorsement by the U.S. Conference of Mayors at its June meeting in Miami. Several religious denominations, most recently the Presbyterians and Unitarian Universalists, have also endorsed the single-payer approach, as have over 400 labor organizations, according to the resolution’s backers.

Bill Holloway, an activist with Health Care for All Texas who helped promote the Austin resolution, said: “This vote is a major victory for those who want to see a more just, rational and compassionate health care system in our state and nation. The resolution makes it clear that managed care and other private insurance company schemes have been miserable failures when it comes to providing care or containing costs.”

“We need to convince our lawmakers in Washington that a more equitable and sustainable system of publicly financed care is possible not tomorrow – but today,” he said. “The people of Austin have spoken: we want single-payer health care.”

Dr. Ana Malinow, a Houston-based pediatrician who serves as chairperson of HCFAT and president of Physicians for a National Health Program, said: “As a physician, I see the toll our broken health care system takes on people’s lives every day – too often leading to their financial ruin, unnecessary suffering, early disability or death. The Austin City Council, by its vote today, has pointed the way forward to a cure – single-payer national health insurance.”

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Health Care for All Texas (www.healthcareforalltexas.org) is a statewide grassroots coalition that believes health care is a human right.

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, visit www.pnhp.org/stateactions or call (312) 782-6006. Spanish-speaking physician-spokespersons are also available.