PNHP

Medicare For All via H.R. 676

Medicare For All via H.R. 676

Stephen Crockett

It is obvious that none of the major Presidential candidates of either the Democratic or Republican Parties are supporting the right approach to providing universal healthcare. Frankly, all the Republican candidates are going to be major obstacles to achieving this national goal. While the top Democratic candidates (Clinton, Edwards and Obama) do support the concept, they are all offering Band-Aid approaches for a life-threatening economic and health crisis in America.

A bill has already been introduced in The House by Congressman John Conyers that effectively addresses the issue. H.R. 676 expands Medicare to cover all citizens.

The scope of the healthcare crisis in America is huge. It has very serious economic and moral implications. It is crippling our nation in terms of protecting American manufacturing, competing in the global economy and undermines our national security. It reflects badly on us as a just and moral society. It is literally killing Americans in huge numbers.

The number of Americans without health insurance is currently 47 million and growing rapidly. The number of underinsured Americans is much larger than the number of uninsured Americans. In America, over half of all personal bankruptcies are the direct result of medical crises. Over half of those bankruptcies are from individuals who had health insurance when their medical crises started.

Industry friendly studies of the number of Americans who died because they had no health insurance place the number at around 50 per week. The number is absurdly low and illogical.

Doing without healthcare at any point in life for a significant period of time will likely create health issues and physical damage. This damage accumulates over a lifetime and shortens your lifespan. You die younger than you would have if you had always had adequate healthcare. You might die at 70 instead of 85. In addition, the last years might have much lower levels of quality. Since most people die after reaching the age where Medicare coverage is already in effect, those deaths are not counted as resulting from a lack of healthcare insurance although they can be directly traced to an earlier lack of coverage. Most of the deaths resulting from a lack of healthcare insurance are thus concealed.

Even using the fraudulent 50 per week figure, killing Americans to preserve the profits of HMO’s and insurance companies is completely immoral. Bankrupting Americans because of illness is a national disgrace. It does not happen in other industrialized nations. Out of the top 75 most industrialized nations in the world, only in the United States are citizens not provided by their government with universal healthcare.

In the United States, we saddle our businesses and corporations with the cost of providing for the healthcare needs of their employees. Our international competitors do not. This is one of the major reasons why good paying manufacturing and service sector jobs are leaving our nation. It is economic suicide.

None of the Band-Aid approaches advocated by the top Democratic Presidential candidates deal effectively with the trade implications of healthcare policy. I am personally supporting Edwards because he is more inclined to advance fair and balanced trade agreements than Clinton and Obama. For example, Clinton and Obama supported the most recent “so-called free trade” agreement with Peru while Edwards did not. However, even Edwards has not yet addressed the clear connection between international trade and healthcare.

The best solution for providing universal healthcare is expanding Medicare to cover all American citizens. Medicare is a proven program. It is popular and cost-effective. Our current private system has much higher levels of overhead costs than does Medicare. The only inefficient aspects of Medicare are the “privatized” programs added by the Bush White House and their Republican allies in the Senate. Medicare has been hugely successful despite ongoing Republican and corporate attempts to undermine it.

We can count on Republican politicians to label any move toward universal healthcare as “socialized medicine.” They attempted mightily to destroy Medicare in the past using such tactics and failed completely. Politically, providing universal healthcare by expanding Medicare will be much easier than any other approach.

The private, profit-drive healthcare system is terribly unfair and inefficient. We spend 17 percent of our total economy on healthcare while our international competitors spend only 8 percent. They cover everyone and we do not. The numbers speak for themselves!

Expanding Medicare to cover everyone will not prevent citizens from buying supplemental healthcare if they can afford it. It will greatly help doctors who are General Practitioners by making medical need become effective demand. It will help hospitals by removing the burden of providing healthcare to those who cannot pay for it. It will make our workers healthier and more productive.

There must be a grassroots movement built behind “Medicare For All.” Local activists, union leaders, businesses and politicians must all exert their efforts in a common movement. Most national union organizations and state AFL-CIO organizations are supporting H.R. 676. They are joined by many members of Congress. The legislation has 89 co-sponsors with more being added frequently. Many candidates are backing it!

Local leaders are already getting organized all over the nation. People like Amos B. McCluney, Jr. in Delaware and Alena Bandy in Maryland are actively organizing Medicare For All state chapters. Both leaders are grassroots Democratic activists with roots in the United Auto Workers. Both are reaching out into the community recruiting civil rights leaders, churches, community organizations and local politicians behind H.R. 676. They are not alone. I personally have talked with local activists from Tennessee, Massachusetts, New York, Pennsylvania and several other states who are working on building support for this legislation.

Pressure must be placed on all opinion leaders to support Medicare For All. Presidential, Senatorial and Congressional candidates should be pressured to support H.R. 676. All candidates should be placed on record that they would not veto Medicare For All nor place legislative obstacles in the way of passing H.R. 676, even if they do not actively support passage. Candidates failing to make such public pledges should not be supported by any American citizen.

Average Americans must reframe the debate over healthcare. Instead of calling for universal healthcare or single-payer healthcare, we should simplify the debate. We should be calling for “Medicare For All” and supporting H.R. 676.

Written by Stephen Crockett (co-host of Democratic Talk Radio http://www.DemocraticTalkRadio.com and Editor of Mid-Atlantic Labor.com http://www.midatlanticlabor.com ). Mail: P.O. Box 283, Earleville, Maryland 21919. Email: midsouthcm@aol.com . Phone: 443-907-2367.

Feel free to publish without prior approval

CIGNA Capitulates to Patient Revolt

Following Massive Protest, Insurer Authorizes

Transplant for 17-year-old Nataline Sarkisyan

CNA/NNOC-Sponsored Protest Sparks Flood of Calls from Across U.S.

In a stunning turn around, insurance giant CIGNA has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkisyan, a 17-year-old girl in the intensive care unit at UCLA Medical Center.

A national web of friends and family of Nataline, CNA/NNOC registered nurses, doctors, members of the Armenian community, healthcare advocates, and netroots supporters pitched in on an unprecedented national day of action on Nataline’s behalf.

The centerpiece of the protests was an impassioned rally today sponsored by CNA/NNOC with the substantial help of the local Armenian community that drew 150 people to the Glendale offices of CIGNA. Hundreds of phone callers clogged the lines of CIGNA offices around the country, all demanding that CIGNA reverse its prior denial of care.

“This is an incredible turnaround generated by a massive outpouring around the country that proves that an enraged public can make a difference and achieve results,” said CNA/NNOC Executive Director Rose Ann DeMoro. “CIGNA had to back down in the face of a mobilized network of patient advocates and healthcare activists who would not take no for an answer.”

The netroot protest was organized by Eve Gittelson, an influential health policy blogger who writes on Daily Kos as nyceve, and many of the calls were also the product of work by the Armenian National Committee.

“Nataline is now seriously ill and still has significant hurdles in her fight for her life, but thankfully our combined voices and protests have finally given her and her family hope,” said Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center.

“However, it is deplorable and appalling that CIGNA needed to have hundreds of people pounding on their doors and besieging them with calls to take the humanitarian step they should have done long before today,” said Jenkins, who spoke at the Glendale rally.

Nataline’s mother, Hilda Sarkisyan, expressed her profound thanks to CNA/NNOC. “We couldn’t have done this without you helping us to stand up against this insurance company and forcing them to finally do the right thing. It is not right in this country for it to take a rally, a protest, and a major press conference to get an insurance company to listen.”

“Every politician who thinks the answer to our healthcare crisis is more insurance should stop and think about Nataline Sarkisyan,” said DeMoro. “Insurance is not care. Paying for insurance coverage is not the same as assuring you will receive appropriate care, even when recommended by a physician as it was for Nataline. Insurance corporations profit by denying care to the sick, and that is no way to run a humane healthcare system.”

DeMoro said that CNA/NNOC will continue to encourage patient protests and publicize stories about insurance companies’ denial of care, as it has all year through its www.guaranteedhealthcare.org website, while pressing for real healthcare reform “that takes medical decisions out of the hands of insurers and places them where they belong, in the hands of healthcare professionals and their families.”

Background on case:

“My daughter survived two bouts of cancer, and against all odds has been stable even with so many of her organs not working, only to be told that she cannot get the only treatment that will save her life because some administrator in some office thinks it is too expensive,” said Hilda Sarkisyan. “We needed help in standing up against this insurance provider, and of course it was the nurses who stepped forward.”

In a Dec. 11 letter to CIGNA’s transplant department, four UCLA physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant and urged the company to “urgently re-review her case” and their denial. CIGNA said it denied the care because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”

On Dec. 14, Hilda Sarkisyan was told by the hospital that a healthy liver was available, but because CIGNA had refused authorization, the family would have had to make an immediate down payment of $75,000 to proceed, an amount the family could not afford.

CNA/NNOC is the nation’s largest and fastest-growing union of direct-care RNs, with some 75,000 members in all 50 states.

Evaluation of Colorado Blue Ribbon Commission for Health Care Reform Final Recommendations

by Michele Swenson
Board Member, Health Care for All Colorado
Co-Authors of Colorado Health Services Single Payer Proposal
January 2, 2008

Overview: Colorado Blue Ribbon Commission for Health Care Reform

(Draft) Final Report / Recommendations to the Colorado General Assembly (Due Date: 1-31-08)

During its 15-month length of service, the Colorado Blue Ribbon Commission for Health Care Reform — comprised of 27 members statewide appointed by two governors and 4 legislators — will have received 31 proposals (23 comprehensive, 7 Single Payer). Five proposals were selected to be evaluated by the Lewin Group, including an additional proposal written by a subcommittee of the Commission. The Colorado Health Services Single Payer Proposal is the only reform proposal that demonstrated any savings for the state — $1.4 billion — and also the only one capable of providing comprehensive health care for all. The Colorado Commission chose to base most of its recommendations on its own (5th) Proposal.

The 208 Commission Recommendations fail to address:

* Rising cost of health insurance premiums (82% increase in 6 years in Colorado), as well as copays, deductibles and prescriptions

* The U.S. fragmented commercial health insurance system that siphons more than 20 percent of health care dollars to profits, exorbitant CEO salaries, etc. and duplicative layers of administrative waste.

* A greater than doubling of median family income spent on health insurance: 7.7% in 1987 to 19% in 2005

* As premium costs continue to increase, coverage has decreased: “Insurance does not equal health care.”

The 208 Commission’s proposed solution:

* A cornerstone of the Commission Recommendation is the Massachusetts-style ‘Individual Mandate’ to purchase private insurance, with a substantial tax penalty for failure to comply.

* The Commission counts heavily on taxpayer subsidies to private insurances.

* The Commission asserts that all cost-shifts are due to the uninsured – yet Lewin’s Graph on Cost Shift shows that the uninsured and underinsured combined (labeled ‘self-pay’) contribute less than 20% to the total cost-shift burden. John Sheils of the Lewin Group informed the Commission that half of all uninsured payer their own health care bills.

* The Commission Recommendation states: “A minimum benefit plan – a leaner health insurance package with high deductibles, annual caps or limited benefits (average monthly premium $200/individual) is considered essential for assuring availability of an affordable product.”

Shortcomings of 208 Commission Recommendations:

* The Massachusetts-style ‘Individual Mandate’ creates a captive market for commercial insurance without attaching either quality or cost controls to insurance charges. In Massachusetts, 2008 marks the 8th year of average double-digit premium increases, resulting in more who cannot afford insurance and are moved into subsidized or public insurance at taxpayer expense. (Boston Globe, 9/13/07, 12/5/07)

* The 208 Commissioin seeks to solve one problem by exacerbating another — by moving more of the uninsured into underinsurance, or Minimum Benefit Plans. Attributing all unpaid medical bills to the uninsured and to under-reimbursed public programs, the Commission disregards the rising trend of unpaid medical bills by the underinsured. The annual TrendWatch Reports of the American Hospital Association reveal that out-of-pocket costs have risen from $146.3 billion in 1995 to $249.4 billion in 2005 – a 59% increase that parallels the 60% increase in unpaid medical bills over the same period. See Graph of Increasing Out-of-Pocket Expenses.

* The Families USA Report Too Great a Burden: Colorado’s Families At Risk (12-13-07) reveals that 1,054,000 people under the age of 65 in Colorado are in families that will spend more than 10% of their family income on health care costs in 2008 before accounting for taxes. Out of these people, the vast majority, 82.6%, have insurance. Out of these Coloradans, 299,000 live in families that will spend more than 25% of their pre-tax income on health care costs in 2008. The numbers of underinsured people have increased since previous studies in 2000, and as a result, put thousands of families at risk due to a growing health care burden. Families USA: Colorado’s Families At Risk

* As premium rates continue to rise faster than the rate of inflation or wage increases, more employers will either drop health coverage or move employees into Catastrophic ‘Minimum Benefit Plans’ with high out-of-pocket costs that leave families vulnerable to increasing health and financial risk, and also contribute to over 50% of personal bankruptcies precipitated by high medical bills.

* The Commission Recommendations add many new categories of coverage, eligibility testing, and new departments of administration, as well as taxpayer subsidization, multiplying administrative and public costs of health care.

Some goals defined by the Commission — “to provide consumers with “a choice of insurances” and to “ensure the ongoing viability of Colorado’s insurance markets” — falsely equate insurance with health care access. People want a true choice of health care, not choice of ‘minimum benefit’ insurances. The Commission Report begs the question: Is reform intended to insure the bottom line of the health insurance industry, or health care access for all?

It is telling what the Commission left out of the final report — Statements from the Vulnerable Populations Task Force Report to the Blue Ribbon Commission, September 28, 2007:

* “Mandating the purchase of a minimum benfits package forces residents to pay for underinsurance and is in direct conflict with the guiding principles of the Commission. We must not exchange our uninsured for masses of underinsured.”

* “The Lewin analysis established that current expenditures in health care would finance comprehensive health insurance for all Colorado residents under the Colorado Health Services proposal with $1.4 billion in savings to the state of Colorado. We should not consider healthcare to be a commodity, as we do not choose to get sick. The Vulnerable Populations Task Force asks the legislature to have the vision to do what is best for all the residents of Colorado. If this is not possible, we offer our recommendations on elements of health reform that could benefit Vulnerable Populations.”

Single Payer merited just 4 sentences in the Commission’s final report. Single Payer: “…viewed by the Commission as being too disruptive of current coverage and also unworkable in a single state.”

Nevertheless, the Single Payer model is uniquely capable of overcoming many problems that the current system and other proposals cannot. No other proposal would create a single Health Trust Fund combining administration of all health care monies, insulated from the politics of the State General Budget (and such constraints as TABOR and Averschoug-Bird, etc.).

Single Payer transparency and accountability of data overcomes the problem of secret proprietary data of numerous private insurance companies, and permits evaluation of best practices and outcomes in a statewide Health Information Technology system. While all other proposals call for substantial increases of state Medicaid spending (funds constrained by General Budget rules that simultaneously limit spending in other areas), Single Payer alone can create a true cost-effective single-risk pool insurance by consolidating multiple categories of medical care that now fall under such categories as Auto, Workers’ Comp and Medicaid/Medicare, to eliminate administrative waste. Single payer can overcome the federal limits on provider reimbursements that hamper Medicaid/ Medicare. Only Single Payer provides true choice of providers a
nd hospitals. Currently, employees’ choice of providers is limited within an employer’s health plan; change of plans requires change of providers, disrupting health care. Improved Coverage & Cost Savings of Colorado Health Services Single Payer Proposal

The Commission’s Reform Proposal sets the stage for a continued downward spiral: As premiums increase and benefits decrease, more people can no longer afford insurance and more are moved into public programs at taxpayer expense.

Free drug samples go to wealthy, insured

By Kim Dixon
Reuters
January 2, 2008

WASHINGTON (Reuters) – Insured and wealthy Americans were more likely than the poor to get billions of dollars in free drug samples distributed by pharmaceutical companies to win patient and doctor loyalty, a study released on Wednesday showed.

The pharmaceutical industry contends that the samples help the uninsured and people with low incomes, but the study of prescription use by nearly 33,000 U.S. residents during 2003 found that the neediest were least likely to get samples.

“Our findings suggest the free samples serve as a marketing tool, not a safety net,” said Dr. Sarah Cutrona, co-author of the report to be published in the February issue of the American Journal of Public Health.

The Pharmaceutical Research and Manufacturers of America, a trade group representing most major drugmakers, called the study out of date and said a major facet of the problem is that many uninsured do not get healthcare from doctors’ offices.

Samples are popular among doctors who want to try new drugs.

“As important as free pharmaceutical samples are in improving healthcare, they represent one – not the only – option for patients in need,” Ken Johnson, a spokesman for the group, said in a statement.

Lack of access to regular medical care by the uninsured and underinsured is a major factor contributing to who gets free drug samples, the report said. The uninsured are more likely to get care from emergency rooms and clinics.

Nearly 47 million people living in the United States do not have health insurance.

NEW, EXPENSIVE DRUGS PROMOTED

About $16.4 billion in drug samples were given out in the United States in 2004, up from $4.9 billion in 1996, the study said. Distributed by sales representatives, samples are nearly always the newest, most expensive drugs, the report said.

Critics have said that in addition to steering doctors and patients to pricey drugs, samples can lead to medications being used for conditions they were not intended to treat.

Drugmakers are forbidden from recommending drugs for uses for which they have not been approved by the U.S. Food and Drug Administration, but doctors can prescribe drugs for any use.

The now-recalled painkiller Vioxx, made by Merck & Co, was the most frequently distributed free drug sample in 2002, the study found.

Vioxx was often prescribed beyond its approved uses before it was withdrawn from the marketplace because of a link to an increased rate of heart attacks and death.

The study analyzed U.S. government data in a 2003 nationally representative survey, and found that about 12 percent of Americans had received at least one free sample.

About 13 percent of those with insurance were given a sample, while about 10 percent of those who were uninsured for all or part of the year got one.

Seventy-two percent of those who received a sample had income in excess of 200 percent above poverty level, while 28 percent had income below poverty level.

William Shrank, a physician at Boston’s Brigham and Women’s Hospital who studies pharmaceutical use in large populations, said the study “helps debunk the assertion” that drug samples help the needy.

Brigham and Women’s Hospital bans sales representatives, but Shrank described how early in his career he worked at academic centers where representatives freely roamed the halls. For doctors short of time and unable to keep up with medical literature, “You are getting biased data. It’s not objective,” Shrank said.

(Editing by Braden Reddall, Leslie Gevirtz, Toni Reinhold)

Where are we on reform? Part 2 (Hacker)

Health Reform Lessons from the Past

Jacob Hacker, PhD
National Conference on the Un and Underinsured
December 12, 2007 (Day 3)

Now I have one big point… and it is that although we are all for the most part health policy wonks, we read Health Affairs, we love to talk about the billions that will be saved doing this and the fine-tuning of mandates and the like, the bottom line is that health care reform is about politics. If real estate is about location, location, location, health care reform is about politics, politics, and politics.

So when the rhetoric heats up reformers are going to have to fight fear with fear. The fear of losing coverage against the fear of government, the fear of medical bankruptcy and debt against the fear of taxes, but they’re also going to have to be able to fight fear with hope. With a clear, simple and unthreatening vision that builds on what exists and meets public concerns head on, a vision that may lack the intellectual satisfaction of a fine-tuned policy blueprint, but which provides the political satisfaction of actually having a chance of passage. Now I think there’s some evidence the reformers have taken this message to heart, though simplicity and clarity still remain pretty elusive in the discussion.

…as we learned this morning, all the top tier Democratic candidates… would include some kind of shared financing requirement with employers either being required to pay or play, and these proposals would all, either eventually or immediately, have some kind of mandate.

Now I think this approach lacks much in terms of conceptual and policy clarity or the inspiration that David Himmelstein provided us earlier today about the sort of large scale reforms we need, but it does have some pretty big political virtues. And I should say I guess in the interests of full disclosure that I’ve been peddling an idea largely along these lines for the last few years. For one thing it means that the vast majority of people who now have private health insurance coverage through their employer would continue to have it.

This time the fight is going to take place on the scorched earth of partisan warfare and that means that we’re going to have to adopt strategies that reflect new political realities. In my view that means a much stronger clarity about ends but much greater willingness to compromise on means, a much greater attention to coalition building from the very beginning, well before a sympathetic President enters office…

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2283

Transcript (Jacob Hacker’s comments begin on page 39):
http://www.kaisernetwork.org/health_cast/uploaded_files/121207-underinsured%20part%202.pdf

Comment:

By Don McCanne, MD

The final Quote of the Day for 2007 discussed the disconnect between a new poll indicating strong support (65%) for “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers,” and a rapidly growing movement within the progressive community to support a model based on allowing you to keep the insurance you have.

Although the policies discussed in that message were on target, the tone was quite negative and detracted from the important thrust of the policies behind the message. The message included inappropriate cynical misdirections of my obvious anger. I decided that in the first message of 2008 I should clarify and expand on the important message in my last qotd, but in a less pejorative manner.

Jacob Hacker has described very accurately the politics of health care reform. He has suggested an approach that, on surface, would appear to lead to affordable coverage for everyone, while passing the crucial test of political feasibility. His political message is very sound – in fact, so sound that the leading Democratic candidates have adopted his suggestions. He has stressed the importance of coalition building well in advance of the installation of a new government one year from now.

So what coalition activities are we seeing within the progressive community? Many respected, influential leaders state that it is time to set aside the policy debate and proceed with a political strategy that will achieve our reform goals. There is one major problem with this approach: most of the difficult policy issues have yet to be addressed. But several of these coalition leaders have told the policy community quite bluntly that the policy debate is over, and all of the activities now must be about unity. We are commanded to unify behind health care reform that promises that you can keep the insurance you have or have the option to buy into a public program.

That’s it. That’s the policy behind which we are to unify. For the sake of unity, we are not to talk about the inability of the private insurance industry to provide us with affordable health plans that are comprehensive enough to meet our health care needs. We are not to talk about a public insurance program that must provide a premium that is competitive with private plans insuring the healthy, when the public plan is weighted down with high-cost patients (adverse selection).

Even though the policy debate is swept under the table, let’s suppose that the political strategy is effective. When we have a Congress and a president who support an individual mandate with a public option, what process will be used to resolve the policy issues? How will they require the private insurance industry to provide reasonably comprehensive plans that are still affordable? How will they create an optional public program with a concentration of the most expensive patients without a massive taxpayer subsidy? What will the voter response be to a program costing far more in taxes than any of the candidates would acknowledge during the campaign?

The policy issues do matter. The politically motivated promise of an affordable individual mandate and an affordable public option cannot be met. Fundamental structural reform is essential. Unless the politicians are able to engage successfully in bait and switch strategies, the gridlock that has prevented reform will be perpetuated.

Jacob Hacker is correct when he states that we need to intensify our coalition building. But he also states that “this approach lacks much in terms of conceptual and policy clarity or the inspiration that David Himmelstein provided us earlier today about the sort of large scale reforms we need.” Also, “In my view that means a much stronger clarity about ends but much greater willingness to compromise on means.”

Those who insist on unity behind political means while suppressing clarity about policy ends will not be successful in coalition building, and clearly that is not Jacob Hacker’s intent. Those of us who insist on clarity about policy ends will be there to be certain that efforts to compromise on means will be an honest, transparent, and fully informed process.

New Hampshire Presidential Primary Televised Health Care Forum

For Immediate Release:

For more information contact:
Dr. Gary Sobelson – NH Medical Society
Ed Helm (727) 637-8362
Josh Peletier (603) 320-9569

HQ: 416 Chestnut St., Manchester, New Hampshire, 03101
January 3, 2008, MCAM (Channel 23, in Studio) 3:30-5:30 PM
540 N. Commercial Street, Manchester New Hampshire

The NH Medical Society announces, along with other NH civic organizations, a televised Forum on the timely topic of where the Presidential Candidates stand on changing US health care, on Thursday, January 3, 2008 at the MCAM Studio from 3:30-5:30 PM at 540 N. Commercial Street, Manchester New Hampshire.

With health care issues the top and most important domestic issue and concern of New Hampshire voters, MCAM (Manchester Community Access Media; Chan. 23) will air and distribute a two hour, live, televised Forum on Thursday, January 3, 2008 from 3:30 to 5:30 PM. The exclusive focus of the Forum with be on Presidential candidate health care proposals and how they compare and contrast. The program will be distributed over the internet via www.mcam.org/mcamtv.htm where it will also be archived and available in the future via the internet.

The NH Medical Society, an inintial co-sponsor of Forum, is represented in the Forum by its former President, Dr. Gary Sobelson who has served as the Chair of the Advisory Committee for the Forum. Dr. Sobelson, in announcing the Forum, stated that,

“The public and the press have begun to really focus on understanding the real differences among the Presidential Candidates on their health care proposals. Recently, a major newspaper’s editorial commented that “Americans are increasing frustrated about the subpar performance of this country’s fragmented health care system, and with good reason.” The newspaper concluded that the “Presidential candidates should be talking about the need for universal health coverage and ensuring that Americans have quick access to a primary care doctor.” Our Forum will help New Hampshire citizens hear the three or so major types of proposals being offered, what they mean and where citizens can find more information about the candidates’ positions on health care changes such as the Kaiser Family Foundations’ www.health08.org. What’s more, the candidates will hear from our citizens and the public through this forum.

Forum Summary

* January 3, 2008, non-partisan, educational, televised Forum in Manchester on Presidential candidate health care proposals to be produced in the MCAM (Manchester Community Access Media) studio from 3:30 PM to 5:30 PM, at 540 N. Commercial St. in Manchester, NH, 03101. The program will be re-broadcast on MCAM (Chanel 23, Manchester NH) on Sunday, January 6, 2008 at 4:00 PM and again at 7:30 PM as well as on Monday, January 7, 2008, at 7:30 PM. A majority of the Public Access Centers around New Hampshire have committed to airing the Forum. Additionally, the MC for the Forum, the host of “Political Chowder,” Ms. Arnie Arnesen, expects the 40 stations which air her program to also re-broadcast the Forum.

* Sponsored by Granite State Physicians for a National Health Program and Co-sponsored by the NH Council of Churches, NH Medical Society, Democracy for New Hampshire, NH Academy of Family Physicians, WMD, NH Citizens for Health Care Freedom, and a number of other New Hampshire civic organizations including Democracy for New Hampshire, WMD (Women Making a Difference) and the NH State Association of Letter Carriers.

* Ms. Arnie Arenson, the MC of the Forum, will be assisted by a distinguished panel who will help analyze the Presidential Candidates’ statements and positions. This panel is led by Dr. Gary Sobelson, former Chair of the NH Medical Society and Chair of the Advisory Committee to the Forum. Other panelists include Ms. Maggie Mahar, author of Money Driven Medicine, Dr. Tomas Claremont, GSPNHP leader and NH family practice physician, and Mr. Charlie Arlinghaus, President of the Concord NH Joshia Bartlett Center for Public Policy.

* Public and citizen participation will help focus the Forum on issues important to them and citizens throughout New Hampshire who will “present” in Medical Society style a range of conditions from the uninsured to those unhappily ‘locked’ in jobs because of health care to how market and preventative health care efforts help and/or hinder the health care system.

The purpose of the MCAM televised Presidential Candidate Forum on Health Care is to help the public hear those candidates talk about their position through pre-taped presentations and submission.

The Presidential Candidates have been asked to respond to these four questions:

1. Summarize your proposal for health care change and identify why it should be seen as better than other candidates’ (one minute)–(also please provide source(s) of additional information about you proposal, e.g., website(s), books, etc. that we can post and identify);

2. How would you provide health care for the 47 million Americans who have no health insurance; how much will your plan cost; how will you pay for it? (two minutes; include ‘more info on’ [website etc.]),

3. In the present American health care system, close to one out of every three dollars does not go for healthcare but rather “Administrative Expenses,” i.e, advertising, profits, etc. with paperwork costs amounting to 16% alone. Discuss your view of whether health care is a right or privilege, service or business, profession or marke t enterprise (one and half minute; more info etc.). And,

4. Why is the United States the only industrial country in the world that permits drug companies to advertise on television and does not have national health care for all its people (30 seconds; more info etc.) Or, the US now spends more per person on health care than any other nation but in most rankings of our health care system, we don’t have the best health care. In fact, we usually come out about 5th or lower in the quality rankings. What would you do to fix this?” (30 seconds; more info etc.)

Representatives of Presidential candidates have been invited to respond to questions about health care issues and their Candidate’s health care proposals.

Dr. Matthew Masewic
(603) 856-7121
Chair Designate GSPNHP

Dr. Gary Sobelson
(603) 225-3427
Chair, Forum Adv. Com.

Edward Helm
(727) 637-8362
Assistant to Chair GSPNHP

Most Free Drug Samples go to the Wealthy and Insured

Contact:
Sarah L. Cutrona, MD, MPH
Steffie Woolhandler, MD, MPH
David U. Himmelstein, MD

Harvard Study Says Samples are a Not a Safety Net Despite Drug Company Claims to the Contrary

Click here to read the study.

Most free drug samples go to wealthy and insured patients and are not used to ease the burden of the poorest nor the uninsured, according to a study by physicians from Cambridge Health Alliance and Harvard Medical School. The study, which is the first to look at free drug samples nationally, will appear in the February, 2008 issue of the American Journal of Public Health.

The study found that use of free prescription drug samples is widespread. More than one out of every ten Americans received one or more free drug samples in 2003. Among Americans who take at least one prescription drug, nearly one out of five got free samples.

Few free samples went to the needy. Insured Americans and those with higher incomes were more likely to report receiving at least one free sample. More than four-fifths of sample recipients were insured all year. Conversely, less than one-fifth were uninsured for all or part of 2003, and less than one-third had low incomes (under $37,000 for a family of four.)

Free sample receipt was consistently higher among those with better access to medical care. Non-Hispanics, English-speakers and Whites were all more likely to receive free samples than were members of ethnic, linguistic or racial minorities. Receiving medical care in an office and taking more medications also increased the chances of receiving free drug samples.

Author Sarah Cutrona, a physician at Cambridge Health Alliance and an Instructor of Medicine at Harvard commented: “The distribution of free samples has become controversial. Evidence shows that free samples may influence physicians’ prescribing behavior and cause safety problems. For instance, we found that the most widely distributed sample in 2002 was Vioxx, with Celebrex being number 3. These drugs turned out to have lethal side effects. While many doctors still view samples as a safety net for their neediest patients, our study shows that samples are potentially dangerous, and do little for the needy.”

Senior co-author David Himmelstein, a primary care physician and an Associate Professor of Medicine at Harvard adds: “Drug companies usually decide which medical office gets which free samples. They distribute samples according to their marketing needs, not our patients’ needs”

“Free drug samples are not the solution to the disproportionately low amount of health care resources going to the poor and uninsured; they are part of the problem,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and study co-author.

Where are we on reform?

Associated Press-Yahoo Poll
Interview dates: December 14 – 20, 2007

14. Which comes closest to your view?

34% – The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance

65% – The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers

2% – Refused / Not Answered

15. Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?

54% – Yes

44% – No

2% – Refused / Not Answered

Full poll results available through link at:
http://news.yahoo.com/page/election-2008-political-pulse-voter-worries

And…

Candidates split along party lines on health

By Tony Leys
The Des Moines Register
December 29, 2007

State Sen. Jack Hatch, a Des Moines Democrat, said his party’s health reformers used to talk more about implementing a “single-payer” system, in which the government would directly insure everyone. But the only presidential candidate still backing that idea is Ohio Congressman Dennis Kucinich, whose campaign is gaining little traction. “The candidates are moving away from that, which shows they’re being realistic,” he said.

Hatch, who is leading a health reform effort in the Legislature, describes himself as one of the most liberal legislators at the Statehouse. But he said that even many lefties like him have decided to back off single-payer proposals and to look for more pragmatic approaches.

Top Democratic presidential candidates all are talking about ways to improve and expand the country’s current mixed system of public and private insurance plans, Hatch said. Their more moderate stances demonstrate their belief that major health care changes can pass if they’re not too extreme.

http://www.desmoinesregister.com/apps/pbcs.dll/article?AID=/20071229/NEWS09/712290325/1012/NEWS11

Comment:

By Don McCanne, MD

We have a disconnect on reform.

From a policy perspective, the nation now believes that “the United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” The majority also supports the concept framed as “single payer,” though the Medicare framing elicits stronger support.

From a political perspective, both the elected and self-anointed elites of the progressive community have chosen to ignore the input of the public at large, and, instead, reframe reform as a model that they believe is a political winner. The words of Iowa State Sen. Jack Hatch (above) express the prevailing framing.

And what is their political goal? They want to create a critical mass of support by including conservatives who believe that everyone should have health care. The problem is that these conservatives still insist that we use the private markets to bring everyone under the umbrella. These are the same people who insist that Social Security is bankrupt and that it can be saved only by privatizing it. These self-appointed progressive elites have to understand that no amount of smooth talking will ever change the DNA of the conservative ideologues.

Although these progressive elites agree that we should establish an optional Medicare-like public program that anyone can purchase, they have narrowly focused their politics by crafting their policies around one single phenomenon that they believe they have discovered. That is that most of us want to keep the coverage we now have.

In all honesty, there are still some private plans that do provide good coverage – good enough that many individuals may not want to deal with the hassles and uncertainties of change. But they also don’t want to even think about potential future insecurities that they might face by hanging on to their current coverage.

Well, they do need to start thinking about it. They need to think about the fact that rules regarding coverage for retirees have just been relaxed, exposing them in the future to the potential of underinsurance or uninsurance. They need to think about the fact that their employer-sponsored coverage is only as secure as their employment, in this age of frequent job changes. They need to think about the fact that the rising costs of health care are impacting their employers causing many to convert to underinsurance, and some to drop coverage altogether. They need to think about the fact that the lack of control over rising health care costs is making coverage unaffordable – a serious challenge should they be thrust into the individual insurance market. They need to think about the fact that the insurance industry continues to expand the market of innovative products – code language for a tradeoff of making premiums affordable by paring down benefits to a level that financial hardships are created for individuals who actually need health care.

OK. So you say go ahead and cover everyone with government programs and subsidies, but still just leave my coverage alone. I’m happy with it, and I don’t want the government messing with it (and I refuse to think about the potential insecurity of the future should any of those frequent events listed take place). Cover everyone? But the costs of adequate coverage now exceed the capability of median-income households to pay for that coverage. Who is going to make up the difference? Doesn’t “government programs and subsidies” mean the taxpayers will? Aren’t you a taxpayer? Do you really want to pay the high costs of your current coverage (even if indirectly through salary reduction) plus pay the taxes to support coverage for the majority of us? Wouldn’t it be far better to have a transparent, equitable process for funding health care for all of us?

The Democrats are placing a bet that politics designed to meet the let-me-keep-my-health-care framing is the key to finally achieving success in reform. It is a bet that will leave us with a choice between unaffordable private plans with inadequate benefits, or a bankrupt public program that is a victim of the death spiral of adverse selection. If we don’t want to place that bet, then we have to tell the self-anointed elite to get out of the way so we can fix our health care system ourselves – in 2008 – by electing politicians who really do represent our views.

A Christmas wish: Health care for all

By Bob Williams
The Record Searchlight
Monday, December 24, 2007

For too many Americans, loss of a job means loss of health care coverage. This has come home today among laid-off workers in the building trades as housing construction tanks. Too many Americans have no health care coverage even though they have a job. Other Americans, with health coverage, find themselves directed to emergency room care when their attack of chest pain occurs on the weekend. There they may sit from 7 p.m. to 11 p.m. until told to go home because the ER can handle only traumatic injury cases.

Health care can be better than this. It can be better if we install a nationwide system instead of the market we now have. Many small businesses cannot afford to offer health care to employees even though they would like to. The market is structured such that a business operator must cover 32 to 50 employees in their plan before getting a significant price break from insurers. This is why less than 50 percent of small-business owners in California offer health insurance while 99 percent of large businesses do.

The United States is the only country, out of 28 industrialized countries, that does not have a universal health care service in place. We have many of the best-trained medical professionals in the world, but of these 28 nations the U.S. ranks 23rd in infant mortality, 20th in female life expectancy, 21st in male life expectancy. Furthermore, among U.N. member states we rank 67th in health immunizations.

These numbers, as usual, are not as meaningful to people as are their own experiences. Many have experienced being unable to move their health insurance from one job to another. Many middle-income people have in the past seven years decided they can no longer afford health insurance.

Detractors like to call universal health care systems “socialized medicine.” Only a few systems worldwide are true socialized medicine in the sense of being totally government-financed through taxes and government-administered. Most universal health systems in the industrialized world are mixed public-private care systems but carefully regulated by a government or nonprofit agency.

We do have one socialized medicine program taking care of about 5 million people in the U.S.; this is the Veterans Affairs Healthcare System. Health experts on a recent ABC News report ranked VA Healthcare as one of the best systems in the country, having fewer medical errors and spending at least $1,500 less per year per patient than even Medicare. Fortunately for qualifying veterans and their families, the phrase “socialized medicine” has never gotten attached to this system in people’s minds. Just as our public education system — publicly financed with tax dollars, regulated, and governed by local boards — has not been labeled “socialized education.”

None of the health care proposals being put forward by presidential hopefuls today are socialized medicine. All involve a combination of government and private financing, uniform standards of record keeping, private providers and choice of provider by individuals. Many worry about government bureaucracy in health care while ignoring the problem of private insurance company bureaucracy. Individuals often have difficulty dealing with the obscure and involved paperwork of the private insurance companies. The private insurance bureaucracy costs the insured a great deal. The 14,000-member Physicians for a National Health Program have published data showing that, in California, only 66 percent of health care funds go for medical care. The remainder — a very large remainder — goes into administering the private insurance system. Approximately 20 percent goes into billing alone.

Just this month the American College of Physicians, the second largest medical association in the U.S., endorsed the idea of single-payer national health insurance to achieve universal coverage. Their statement in the Annals of Internal Medicine read: “Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access.”

A single-payer system can reduce administrative costs of health care to levels comparable to that of Medicare, currently estimated at approximately 3 percent. That is far different from the wasteful and inefficient health care delivery we have now. It is, in effect, Medicare for all.

Change is coming in our health care system because people demand it. It could be minor tinkering, which will require more tinkering year after year, or it could be significant change. It will not happen this Christmas and not next Christmas, but this could be a gift to all Americans in the Christmas after.

Bob Williams is a Millville rancher, a past president of the cattlemen’s association, and a retired UCLA professor of anthropology. His e-mail address is wmsranch@redding.net.

The insured should be very, very afraid

Too Great A Burden: America's Families at Risk

Families USA
December 2007

Health care costs have become a growing burden for America’s families, as premiums and out-of-pocket expenses continue to rise at alarming rates.

Families USA commissioned The Lewin Group to analyze data from the U.S. Department of Health and Human Services and the Census Bureau.

Millions of Insured Americans Are Affected

* More than four out of five people (82.4 percent) in families spending more than 10 percent of their pre-tax income on health care costs are insured.

* 50.7 million non-elderly Americans with insurance are in families that will spend more than 10 percent of their pre-tax income on health care costs in 2008.

* More than three out of four people (75.8 percent) in families spending more than 25 percent of their pre-tax income on health care costs are insured.

* 13.5 million Americans with insurance are in families that will spend more than 25 percent of their pre-tax income on health care costs in 2008.

http://www.familiesusa.org/assets/pdfs/too-great-a-burden.pdf

Comment:

By Don McCanne, MD

For health reform advocates, this report is well worth downloading. It confirms not only the enormity of the financial burdens of health care, but also the alarming rate of increase in those burdens.

Since most reform proposals would build on our private insurance system, the numbers above were extracted from this report to demonstrate just how ineffective insurance is in protecting the finances of non-elderly Americans who are fortunate enough to be insured.

I won’t repeat the numbers here, but read them again. Now read them once more, and absorb them.

Our insurance industry has failed miserably to protect us from financial hardship and even personal bankruptcy. No amount of insurer regulation can reverse these trends because the private insurance industry cannot provide insurance products with premiums plus out-of-pocket expenses that have a stop-loss of 10 percent of income. More than fifty million non-elderly, insured Americans can already attest to that.

The neoliberal view expressed by the leading Democratic candidates for president is that those healthy individuals who would rather keep the insurance they have should be able to. But those individuals need to understand that insurance that works well while you’re healthy and don’t need it, has not worked for fifty million others in our nation. Over a lifetime, those odds can catch up with almost everyone.

So why can other nations such as Switzerland and the Netherlands rely on private plans (albeit highly regulated) to finance health care? The answer is simple. Over $2.2 trillion is what we’re already spending on health care. On a pro rata basis, that is $7500 per person. That requires an income of over $75,000 to limit an individual’s pro rata share to under 10 percent of income. For a family of four, an income of $300,000 would be required.

Health care is too expensive. Segregated private insurance risk pools no longer work. If we want everyone to have affordable access to health care, we are going to have to establish a universal risk pool, and ask the wealthy to step up and return to us, in the form of health care, just a small amount (for them) of the great rewards they have received from our entrepreneurial system. If they are not willing to do that (by supporting health care financing through progressive taxes) then we are going to have to continue to sit back and watch people suffer needlessly and die prematurely. The rest of us simply do not have the funds to prevent that.

Private health insurance offers us sickly benefits

By JIM McMEANS
Atlanta Journal-Constitution
Op-Ed
Published on: 12/21/07

President Bush on Dec. 13 vetoed the SCHIP renewal bill that would have expanded government health insurance to thousands more needy and sick children. The president said, “… our nation’s goal should be to move children who have no insurance to private coverage, not to move children who have private health coverage to government coverage.”

Bush also said, “the bill … moves our health care system in the wrong direction.”

But more than any other factor, private health insurance coverage is the reason why the United States has a dysfunctional health care system in which over 45 million Americans lack coverage and approximately another 40 million have unreliable coverage. Americans who have unreliable coverage are sometimes called the underinsured. A better description is Americans who have private health insurance.

In contrast to what he wishes to impose on his fellow Americans, President Bush spent much of his childhood with taxpayer-funded health insurance, or as he calls it, “socialized” health care, under his father’s taxpayer-provided government health insurance policy.

As governor of Texas, Bush and his family’s health insurance was taxpayer-subsidized. Bush has received health care from the taxpayers as president and he and Laura Bush will continue to enjoy the benefits of “socialized medicine” for the rest of their lives.

Rudy Giuliani is another strong advocate of private health insurance for the common folk. But he has enjoyed taxpayer-subsidized health insurance for almost his entire working life. Giuliani clerked for a federal judge for a year after graduating from law school in 1968, then went to work for the Department of Justice, with a four-year exile at a private law firm during the Carter presidency. He then returned to the Department of Justice from 1981 to the early 1990s before serving as mayor of New York for eight years beginning in 1993.

Is Giuliani running for president because he knows that if he were a typical American prostate cancer survivor working in the private sector, he would not be able to obtain a health insurance policy that would pay for the medical treatment he needs if his cancer reappears?

Tony Snow, who as spokesperson for the Bush administration frequently touted the “benefits” of private health insurance, is another cancer survivor who was fortunate to have government-sponsored, federal taxpayer-subsidized health insurance when his cancer returned. If Snow had left Fox News to begin a career as an independent small businessman instead of going to work for the government, he would not have been able to obtain a health insurance policy from the private health insurance industry that would have covered the treatment of his cancer. Both his life and his family’s financial security would have been put at risk.

Private equals predatory

While it’s not realistic for the average American to expect to have health insurance as good as the president of the United States, why can’t all Americans have health insurance as reliable and affordable as Tony Snow?

When so many individuals who avoid private health insurance are prescribing it for the rest of us, it’s important that they understand the consequences of the policies they are advocating for the American people.

Millions of Americans are reasonably happy with their health plans, but for the most part, they don’t have private health insurance. Americans who work for the government or for large corporations generally enjoy reliable and reasonably affordable employer-sponsored health plans, in which the employer assumes the monetary risk for most or all of the employee’s medical costs. In some of these plans, a private health insurance company shuffles the paperwork and negotiates prices with medical professionals, but the health insurance company does not risk its own money. Whether an employee enjoys reliable and affordable health care benefits seems to be determined by whose money is at risk, the employer or the private health insurance company.

Private, for-profit health insurance sold to individuals is almost always predatory health insurance. Millions of Americans like myself already have private health insurance, and unlike President Bush, I wouldn’t wish private health insurance on my worst enemy.

Some of the warning signs of predatory health insurance are denying health insurance coverage to those who need it; pre-existing condition limitation clauses; $2,000 and up deductibles that increase by the thousands each year; and finally, premium increases larger than general inflation or medical inflation.

The purpose of the inexplicably large premium increases is to induce the policyholder to drop the policy after three to five years, which according to industry statistics, is when previously healthy policyholders begin to get sick and file claims. The industry term for this practice is “churning.” If you have ever been hit with a premium increase larger than the rate of medical inflation, you have been “churned.”

Stockholders come first

It may seem incredible to some entrepreneurs that a business would chase away paying customers, but it’s true in the health insurance industry. Policyholders are not assets, but liabilities on a private health insurance company’s moral balance sheet. A policyholder with a chronic illness can run up hundreds of thousands of dollars worth of medical bills a year while paying less than $10,000 a year in premiums. Like any for-profit business, a commercial health insurance company’s first obligation is to the stockholders, not the policyholders, and as a result, private health insurance companies have a conflict of interest with their policyholders. The economic reality is that it is basically impossible to run a for-profit health insurance company honestly and still obtain the 15 percent and higher return on investment demanded by stockholders and board members.

I can testify first hand as to the existence of churning. As a self-employed independent bookseller, over the last 15 years, I have purchased private health insurance policies from five different for-profit health insurance companies. Before you accuse me of being flighty, please note that I have had the same car insurance policy for over 30 years and the same house insurance policy for 20 years.

So why did I take the risk of changing health insurance companies so many times? The truth is I was forced out of each of those policies within three years by yearly premium increases of 20 to 90 percent. At no time during that period did I ever file a claim or even go to the doctor.

In March 2005, I purchased an individual policy for myself from Blue Cross Blue Shield of Georgia. The cost was $165 a month with a $2,000 deductible and a 70/30 co-pay with a maximum of $2,000 out of pocket, not including some other minor miscellaneous co-pays. That was about the typical market price for a policy for a healthy 55-year-old man. Politicians who push consumer choice health plans and catastrophic health insurance policies usually cite similar figures in their speeches.

It’s true, as the politicians say, that an individual can sign up for a health insurance policy with a $2,000 deductible for around $200-250 a month depending on age. The problem is he or she can’t keep it.

111% premium hike

In October 2005, I was notified that as of Jan. 1, my Blue Cross health insurance premium was being raised to $314 a month, a 90 percent increase in less than one year. Or, I was given the option to raise my deductible from $2,000 to $3,500 and only face a 45 percent premium increase to $240 a month. These increases came at a time when general inflation was approximately 5 percent and medical inflation approximately 10-12 percent.

Did I mention that I never filed a claim or even went to a doctor that year?

I chose to raise the deductible to $3,500 and absorb the 45 percent increase. Fortunately, the co-pay remained $2,000.

In October 2006, I was notified that my premium was being raised to $283 as of Jan. 1, an increase of 18 percent. The new premium of $283 was an increase of 72 percent in my health insurance premium in one year and nine months.

Fortunately, I did not fall ill, did not file a claim or even go to a doctor in 2006.

Now, as of October 2007, I have been notified that my premium is being raised to $349. That figure represents an increase of 111 percent in my Blue Cross health insurance premium in two years and nine months.

I haven’t decided yet whether to keep this policy, raise the deductible or try to get another policy. But based on my past experiences with the other four health insurance companies, I believe I can safely predict that my Blue Cross premiums will be increasing next year, an election year, by about 20 percent and the year after by anywhere from 30 to 90 percent.

Americans would be wise to emulate Bush and Giuliani and go to work for the government and obtain taxpayer-subsidized health insurance, or get a job with a large corporation that provides an employer-sponsored health care benefit plan.

My advice is to avoid private health insurance like the plague.

Jim McMeans lives in Danielsville

Insurance and cancer

Report Links Health Insurance Status With Cancer Care

American Cancer Society
December 20, 2007

Uninsured Americans are less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts, according to a new American Cancer Society report examining the impact of health insurance status on cancer treatment and survival.

American Cancer Society researchers analyzed 598,635 cases using the most recent data from the National Cancer Data Base (NCDB), a hospital-based registry held by ACS and the Commission on Cancer of the American College of Surgeons. The NCDB tracks approximately 70% of the cancer cases in the United States and collects data from about 1,500 hospitals. The patients included had either private insurance, Medicaid, or no insurance. The researchers also examined data from the 2005 and 2006 National Health Interview Survey (NHIS), a nationwide in-person survey of approximately 40,000 U.S. households conducted by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC).

For all cancers combined, the ACS researchers found that uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance.

People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense.

Individuals with health insurance were about twice as likely as those without to have had a recent mammogram or colorectal cancer screening. People with insurance were also more likely to be diagnosed with early stage disease and less likely to be diagnosed with advanced stage disease than the uninsured.

The researchers saw a survival difference in breast and colorectal cancer, too. About 89% of privately insured white women with breast cancer survived at least 5 years, compared to 76% of white women with Medicaid or no insurance. Among African-American women, 81% of breast cancer patients with private insurance survived 5 years, compared to 65% of those on Medicaid and 63% of those without insurance. A similar pattern emerged in colorectal cancer. Among white patients with private insurance, 66% survived 5 years, compared to 50% of those with no insurance and 46% of those on Medicaid. Among African Americans, 60% with private insurance survived 5 years compared to 41% of the uninsured and Medicaid patients.

The risk of being uninsured or underinsured varies.

Almost anyone can be underinsured in the event of a major illness. The underinsured, commonly defined as people who spend more than 10% of their after-tax household income on out-of-pocket expenses in the event of a serious illness, often don’t realize the gravity of their situation until faced with high premiums and deductibles, limits on terms for covered services, and caps on monthly, lifetime, or disease-specific coverage.

According to a 2003 study sponsored by the Agency for Health Care Research and Quality, the prevalence of being underinsured increased from 6.7% to 8.5% among nonelderly adults between 1996 and 2003. These numbers shot up when the costs of health insurance premiums were factored in. Among people with cancer, 29% had out-of-pocket expenses that exceeded 10% of their family’s income and about 11% exceeded it by 20%.

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp

“Association of Insurance with Cancer Care Utilization and Outcomes” January/February 2008 issue of CA: A Cancer Journal for Clinicians, published by the American Cancer Society:
http://caonline.amcancersoc.org/

Comment:

By Don McCanne, MD

There are many factors that influence access and outcomes for cancer patients. This comprehensive study confirms that insurance status is one of the most important factors. The uninsured are screened less frequently; they are diagnosed at a later stage, and they have a lower survival rate.

Because of socioeconomic and other factors, insuring everyone will not eliminate these disparities. But financial barriers perpetuate and intensify the disparities. The crucial first step to improve health care for cancer patients (and for all other patients) is to remove financial barriers by including everyone in a comprehensive national health insurance program.

This study raises another important issue. Not only is insurance coverage crucial, the nature of that coverage counts as well.

Somewhat shocking is that the survival of Medicaid patients in this study was no better than that of the uninsured. Part of this is likely due to the reality that Medicaid is a chronically underfunded medical welfare program. Many health care providers refuse to accept Medicaid patients. Using Medicaid to reduce financial barriers is of little help when the health care delivery system has shut its doors to those enrolled in the program.

Another factor that may result in a lower survival rate for Medicaid patients is that many were previously uninsured or lost the coverage they had, so they use Medicaid as rescue coverage, inevitably entering the system at a later stage of their disease. But this only further confirms that it is not an adequate substitute for continuous comprehensive coverage that provides sufficient funding for the health care delivery system.

Another important reason that universal insurance coverage alone is not enough is that underinsurance has become a source of financial hardship, precisely for those with significant health care needs such as cancer patients. Not only does underinsurance create a hardship, it also is a barrier to care when the patient cannot afford his/her expensive chemotherapy because it isn’t covered by the plan.

Medical welfare programs and inadequate coverage can never patch the vast holes in our health care system. Again, there is much to be done, but all other efforts will be relatively feeble until we remove financial barriers to care for everyone by enacting a single payer national health insurance program. That’s the easy step. Then we need to go to work.