PNHP

Underwriting is part of the problem

Underwriting is part of the problem

The Quote of the Day for October 31, 2007 was from a Modern Healthcare article, “Universal healthcare crosses the partisan divide,” which mentioned that many attendees at the meeting of the Health Industry Group Purchasing Association seemed to believe that, “Like it or not, within the next few years the U.S. is going to have a nationwide, single-payer system.” Following is a response to that article, and two responses to the response.

qotd: “Conservative businessmen sound out single payer”
https://pnhp.org/news/2007/october/conservative_busines.php

Why single-payer is not inevitable

Modern Healthcare
November 2, 2007

A recent article, “Universal healthcare crosses the partisan divide” argued that—like it or not—a single-payer system is inevitable in the U.S. While I wholeheartedly agree that we need to provide every American with access to quality healthcare coverage, I cannot and will not believe that it will come from a government-run model. While such a system has the potential to provide universal access to care, it would do so at the devastating cost of quality and choice.

Under a single-payer system, the government would hold a monopoly over coverage, offering a one-size-fits-all insurance plan. So when the government decides to reduce or deny funding for treatments determined to be too costly, an individual has to forgo potential life-saving treatments, or finance them out-of-pocket. This is on top of the perilous problems other countries have encountered with this system, including substandard care, long waiting lists, loss of physicians, forced outsourcing and healthcare rationing.

No one is denying the need for healthcare reform or the moral imperative of providing healthcare access to all Americans; but I absolutely disagree with the idea that we can only accomplish these things through a single-payer system. We need to consider alternative healthcare reform solutions, such as free-market reform, and just say no to single-payer.

Janet Trautwein
Chief executive officer and executive vice president
National Association of Health Underwriters
Arlington, Va.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071102/FREE/311020008/-1/dailydialogue

Free-market approach is making care unaffordable

Modern Healthcare
November 8, 2007

In her comments “Why single-payer is not inevitable,” Janet Trautwein asserts that a single-payer system would force an individual to “forgo potential life-saving treatments, or finance them out-of-pocket.” She recommends instead free-market reform, presumably private health plans.

She has it backwards. A single-payer system would provide comprehensive benefits and would eliminate financial barriers to care. Private health plans keep their premiums competitive by reducing benefits covered and increasing out-of-pocket spending through patient cost-sharing. This free-market solution of underinsurance is making healthcare unaffordable for many.

Her support for private plans is no surprise. As chief executive officer and executive vice president of the National Association of Health Underwriters, she represents an industry that exists for the purpose of protecting private insurers from the costs of individuals who need healthcare. In sharp contrast, a single-payer system is designed to protect individuals with healthcare needs from the high costs of that care.

Under a single-payer system, the administrative waste of the health underwriters would be eliminated along with the waste of the private health plans. That would benefit us all.

Don McCanne, M.D.
San Juan Capistrano, Calif.
Senior health policy fellow
Physicians for a National Health Program

And…

In other countries, nationalized healthcare works
Regarding “Why single-payer is not inevitable:”

I have to disagree with this extremely biased opinion piece (the piece by Janet Trautwein), written by someone with a vested interest in maintaining the status quo.

Nationalized healthcare works well in industrialized countries outside the U.S. Sure, there are problems and limitations, but Britain, France and Canada have healthy economies with strong currencies. Their national healthcare programs improve the quality of life for their citizens as a whole and don’t hurt their respective standards of living. When one in seven Americans don’t have adequate health care, it’s time for a change.

Graham Moore
Supervisor
Regional access programs
Vancouver (British Columbia) Coastal Health Authority

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071108/FREE/311080010/1025/FREE

Comment:

By Don McCanne, MD

Graham Moore and I already said it.

Highmark's Healthcare Gift Card

Highmark offers the ultimate get-well card

By Bill Toland
Pittsburgh Post-Gazette
November 2, 2007

Highmark Inc., the Pittsburgh-based health insurer, hopes its new Healthcare Gift Card will encourage people who might be reluctant to visit the doctor or spend their money on prescriptions… to do so.

The card itself costs $4.95 (plus shipping and handling), and can be loaded with as little as $25… to as much as $5,000.

“Ultimately, we think this product may go national,” said Kim Bellard, Highmark’s vice president of e-marketing and consumer relations. He expects other insurers will be interested in using the “intellectual technology,” which Highmark hopes to patent.

“We do expect other people to follow,” he said. “We certainly expect phone calls from other Blues plans. … I would love to get a phone call from AARP.”

If the patent is received, any insurer or organization that tries selling a similar gift card may owe Highmark royalties.

Highmark partnered with Visa in developing the card, which can be used just like a Visa credit card or debit card, but only at merchants that Visa has categorized as health-related.

But couldn’t you just take the gift card to Rite Aid and spend it on a case of Coca-Cola and a bag of Snickers bars? “We obviously don’t advertise that,” Mr. Bellard said. But the answer is, yes — for now.

http://www.post-gazette.com/pg/07306/830560-85.stm

To purchase the cards:
http://www.givewell.com/

Comment:

By Don McCanne, MD

Any innovation that the health insurance industry can devise to drum up more administrative fees, they’ll do. In this instance, Highmark wants not only more fees, but they also want other insurers’ administrative fees as well, claiming its patent rights to the intellectual capital.

As long as we leave the private insurance industry in charge, we’ll see more and more of these efforts to soak us with additional administrative costs. It reflects the fundamental differences in the mission of the private insurance plans (profitable business model), and what would be the mission of our own single payer national health program (health care justice for all).

Is covering the state's uninsured worth $1.1 billion?

The Daily Camera
Saturday, November 3, 2007

The state’s blue-ribbon health-care-reform commission figures it would cost $1.1 billion to implement a sweeping measure under which all Coloradans would have to buy health insurance. The commission’s work is aimed in part to address the fact that nearly 790,000 residents are uninsured. The numbers are preliminary, but the question remains: Is this the right direction for Colorado? That question was posed this week to the Camera’s editorial advisory board.

Requiring people to buy health insurance is better than nothing, but it is not a comprehensive solution to the health-care and cost crisis.

There appear to be two major issues that health-care reform needs to address. First, our current system of multiple for-profit insurance companies wastes enormous amounts of money on duplicate administration, risk-avoidance and coverage disputes, estimated by some at 30 percent of total health care costs. And second, medical costs are hugely increased by uninsured people delaying diagnosis and treatment and then ending up in emergency rooms. Mandating the purchase of health insurance covers the second problem, but does nothing for the first.

A much more efficient and cost-effective approach would be to have a single-payer approach, like Medicare, available to all citizens, with this single entity paying hospitals and doctors for people’s basic needs. Clearly, setting the level of basic coverage would be a real political issue. And forcing health insurance companies to use common administrative procedures, to make supplemental coverage available to all, and to have their policies be fully transferable could be another bowl of hot potatoes. But these issues are not insurmountable, and taking them on will need to be done in any case.

Finally, the single-payer approach provides savings from eliminating unnecessary costs that will help to cover the increased level of basic care that currently is simply not provided, so the final societal bill may not increase dramatically, and may even be reduced.

Steve Pomerance

Access to health care a question of justice

Letters to the Editor
The Baltimore Sun
November 4, 2007

I applaud the comments in The Sun’s column “Say yes to national health care” (Opinion – Commentary, Oct. 29).

As a medical student, I see the impact our broken health care system has on individuals and communities every day.

Figures from the Institute of Medicine show that the lack of health insurance causes about 18,000 unnecessary deaths every year in this country.

Medical students see the faces behind this number in our free clinics and emergency rooms. The patients who die under our care largely die from preventable diseases. We need a single-payer health care system to prevent these deaths.

We have tried the market-driven model of medical care – with its underlying motto of “We feel for you, but our shareholders come first.”

Many states are trying hard to come up with solutions. But although well-intentioned, these approaches often put too much financial burden on workers who are forced to buy insurance.

It is clear that we need a fundamental change to stop the human suffering we now have, and cut the health care costs that are hurting the economy.

I believe we have reached a point in history at which this is no longer just a political or economic issue; it is a justice issue.

Jay Bhatt
Philadelphia

The writer is a former president of the American Medical Student Association and board member of PNHP.

Highmark’s Healthcare Gift Card

Highmark offers the ultimate get-well card

By Bill Toland
Pittsburgh Post-Gazette
November 2, 2007

Highmark Inc., the Pittsburgh-based health insurer, hopes its new Healthcare Gift Card will encourage people who might be reluctant to visit the doctor or spend their money on prescriptions… to do so.

The card itself costs $4.95 (plus shipping and handling), and can be loaded with as little as $25… to as much as $5,000.

“Ultimately, we think this product may go national,” said Kim Bellard, Highmark’s vice president of e-marketing and consumer relations. He expects other insurers will be interested in using the “intellectual technology,” which Highmark hopes to patent.

“We do expect other people to follow,” he said. “We certainly expect phone calls from other Blues plans. … I would love to get a phone call from AARP.”

If the patent is received, any insurer or organization that tries selling a similar gift card may owe Highmark royalties.

Highmark partnered with Visa in developing the card, which can be used just like a Visa credit card or debit card, but only at merchants that Visa has categorized as health-related.

But couldn’t you just take the gift card to Rite Aid and spend it on a case of Coca-Cola and a bag of Snickers bars? “We obviously don’t advertise that,” Mr. Bellard said. But the answer is, yes — for now.

http://www.post-gazette.com/pg/07306/830560-85.stm

To purchase the cards:
http://www.givewell.com/

Comment:

By Don McCanne, MD

Any innovation that the health insurance industry can devise to drum up more administrative fees, they’ll do. In this instance, Highmark wants not only more fees, but they also want other insurers’ administrative fees as well, claiming its patent rights to the intellectual capital.

As long as we leave the private insurance industry in charge, we’ll see more and more of these efforts to soak us with additional administrative costs. It reflects the fundamental differences in the mission of the private insurance plans (profitable business model), and what would be the mission of our own single payer national health program (health care justice for all).

Is covering the state’s uninsured worth $1.1 billion?

The Daily Camera
Saturday, November 3, 2007

The state’s blue-ribbon health-care-reform commission figures it would cost $1.1 billion to implement a sweeping measure under which all Coloradans would have to buy health insurance. The commission’s work is aimed in part to address the fact that nearly 790,000 residents are uninsured. The numbers are preliminary, but the question remains: Is this the right direction for Colorado? That question was posed this week to the Camera’s editorial advisory board.

Requiring people to buy health insurance is better than nothing, but it is not a comprehensive solution to the health-care and cost crisis.

There appear to be two major issues that health-care reform needs to address. First, our current system of multiple for-profit insurance companies wastes enormous amounts of money on duplicate administration, risk-avoidance and coverage disputes, estimated by some at 30 percent of total health care costs. And second, medical costs are hugely increased by uninsured people delaying diagnosis and treatment and then ending up in emergency rooms. Mandating the purchase of health insurance covers the second problem, but does nothing for the first.

A much more efficient and cost-effective approach would be to have a single-payer approach, like Medicare, available to all citizens, with this single entity paying hospitals and doctors for people’s basic needs. Clearly, setting the level of basic coverage would be a real political issue. And forcing health insurance companies to use common administrative procedures, to make supplemental coverage available to all, and to have their policies be fully transferable could be another bowl of hot potatoes. But these issues are not insurmountable, and taking them on will need to be done in any case.

Finally, the single-payer approach provides savings from eliminating unnecessary costs that will help to cover the increased level of basic care that currently is simply not provided, so the final societal bill may not increase dramatically, and may even be reduced.

Steve Pomerance

Oregon rejects health care for children?

Health plan gets burned after state's costliest race

By Janie Har
The Oregonian
November 7, 2007

After the most expensive political campaign in Oregon history, voters Tuesday overwhelmingly rejected a tobacco tax increase to pay for children’s health care.

The 3-to-2 vote against Measure 50, which would have increased Oregon’s cigarette tax by 85 cents a pack, follows similar defeats in California and Missouri after tobacco makers spent millions to oppose the measures.

In Oregon, Reynolds American and Philip Morris, the makers of Camel and Marlboro cigarettes, spent a record $12 million, primarily on a TV commercial blitz.

The decisive failure kicks a complex public health issue back to the Legislature and Gov. Ted Kulongoski, who have been unable to make health care more accessible for an estimated 576,000 Oregonians who lack insurance.

http://www.oregonlive.com/news/oregonian/index.ssf?/base/news/1194420305233310.xml&coll=7

Comment:

By Don McCanne, MD

What is it that we keep hearing?

“Only incremental steps can get us to comprehensive reform.”

“Let’s not make the perfect the enemy of the good.”

“Everyone’s second choice for reform is the status quo.”

“We don’t need a government system. We need to build on what is working.”

Because of perceptions of lack of political feasibility, we continue to reject comprehensive reform and instead direct our efforts to supporting measures that we believe are actually doable.

This measure couldn’t fail. Everyone supports health care for children, and almost everyone supports tobacco taxes that would give smokers a greater incentive to quit. Only the evildoers in the tobacco industry would be opposed.

Well, people in Oregon watch TV, and the vested interests with a lot of money control the message. The tobacco companies were able to frame this as an issue over taxes and government accountability. Who believes that we need more taxes? Who supports the ubiquitous inefficiencies of government bureaucracies?

Our goal is affordable, comprehensive, high-quality care for everyone. The vested interests that stand to lose will always be opposed. But they will also vigorously oppose the “politically feasible” incremental measures that do not serve their interests.

Don’t dilute our message. Continue to speak up loud and clear in support of the comprehensive reform that we need. But reject the self-serving framing of the opponents and use our moral framing of EMPATHY and RESPONSIBILITY for us to see that the health care needs of all of us are met.

The United States needs a 'single-payer health care system

James Clancy addresses Physicians for a National Health Program in Washington

Washington (6 Nov. 2007) – Time has validated Canada’s publicly-funded national health care system and the United States should move toward a similar system, says James Clancy, president of the National Union of Public and General Employees (NUPGE).

Speaking to an American group called Physicians for a National Health Program (PNHP), Clancy said only a small minority of people in Canada favour private health care solutions such as private insurance, user fees, medical savings accounts and parallel for-profit care.

“The vast majority of Canadians have repeatedly said No to these proposals, because the principles on which these proposals rest cannot be reconciled with the values at the heart of our medicare,” Clancy said.

“The opponents of our single-payer system claim it’s a perversion of Canadian values that they can’t use their own money to purchase faster treatment from a private for-profit provider,” he added.

“But the consensus view of Canadians on this issue is clear: It’s a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to health care.”

Medicare defines Canada

Clancy said medicare defines the values of Canada. “Sickness doesn’t discriminate. And in Canada we’ve made the collective decision that health care shouldn’t discriminate either,” he said.

“Overwhelmingly, Canadians strongly support the core values on which our system is premised: equality, compassion and social solidarity. In fact, our medicare system is now tied to our understanding of citizenship – more than a social program, medicare to us represents a birthright and an identifying mark of Canadian-ness.”

On five occasions since national public health care was established in Canada more than 40 years ago, the system has been reviewed by high-profile political and judicial leaders, he noted. “All came to the same conclusion: single-payer, publicly-funded health care is more equitable, more efficient and more effective,” he said.

He acknowledged that problems, such as wait times, exist within the Canadian system but he said solutions also exist and will be far less costly to implement than in the U.S. Canada spends about 10% of GDP to finance its health care system, which covers all citizens. The U.S. spends roughly 15% of GDP yet leaves millions with no coverage at all, he noted.

Clancy said wait times are not caused by Canada’s single-payer system.

Health professionals

“The main source of the problem is something most countries around the world are experiencing: we’re facing a health human resources crisis,” he argued.

“There’s a serious shortage of health professionals in Canada. They’re retiring in big numbers. And we’re just not recruiting and training enough new health professionals.

To be successful in reducing those waiting lines, we’re working with Canadian governments to invest in a national strategy that will lead to a greatly expanded workforce of health care professionals.”

Clancy said the challenge is for groups such as NUPGE and PNHP to work together to bring “a single-payer system in the U.S.” while continuing to defend and expand the system that exists in Canada.

“If we continue to fight with passion and conviction and hold out for what we want, we’ll do more than make a difference in health care. We’ll create a world of which we can all be truly proud. Working together – we can make that happen,” he said.

Nurses Across Nation Host SiCKO House Parties to Urge Guaranteed Healthcare as DVD Released

Registered Nurse Response Network
Press Release

OAKLAND, Calif., Nov. 5 PRNewswire — Michael Moore’s healthcare “horror” film SiCKO will continue its unique impact on American society and politics with its Nov. 6 DVD release, which will be commemorated with more than 125 nurse-led house parties around the nation, the Registered Nurse Response Network (RNRN) reports today. Call for information about house parties in your area.

The house parties, stretching from Alabama to Idaho, build on the “Scrubs for SiCKO” campaign during the movie’s summer debut which saw over 10,000 nurse volunteers gathering outside theaters and talking to the public about achieving genuine healthcare reform.

The goal of the house parties is to build support for the kind of guaranteed, single-payer healthcare systems that are succeeding in every other industrialized democracy — a point Moore makes powerfully in the movie. Nurses will strategize about how to use patient advocacy to help pass single-payer/Medicare-for-all-type legislation such as Rep. John Conyers’ HR 676 now pending in Congress, and make it a central focus of the presidential campaign.

Nurses are crucial to the public education campaign about how single-payer healthcare, guaranteeing comprehensive, quality healthcare with an expanded and improved Medicare for all, is far superior to the profit-driven, industry-centered healthcare sector that has come to dominate American medicine.

“SiCKO” profiles a number of Americans with insurance who have been denied needed care by their insurance companies, describes how the insurance-based healthcare system is structured to keep it that way, and provides examples of other industrialized nations where insurance companies do not stand in the way of medical care.

HR 676 and similar bills in several state legislatures would have one public entity collecting and disbursing all revenues for care delivered by our current, mostly private hospitals, clinics, and doctors, similar to how Medicare works.

The Registered Nurse Response Network is a project of the California Nurses Association/National Nurses Organizing Committee which represents 75,000 RNs in all 50 states.

Registered Nurse Response Network

Worsening the Odds

Being Uninsured is a Major Cause of Death

Bob Herbert
New York Times
November 3, 2007

Lonnie Lynam, a self-employed carpenter in Pipe Creek, Tex., specialized in spiral staircases. Friends thought of him as a maestro in a toolbelt, a whiz with a hammer and nails.

“His customers were always so pleased,” his mother told me. “There was this one family, kind of higher class, and he built them one of those glass holders that you would see in a bar or a lounge, with the glasses hanging upside down in different sizes. It was awesome.”

Lonnie had a following, a reputation. He was said to have a magic touch.

What he didn’t have was health insurance.

So when the headaches came, he tried to ignore them. “We’ve had migraines in our family,” said his mother, Betty Lynam, who is 67 and lives in Creston, Iowa. “So he thought that was what it was.”

Lonnie’s brother, Kelly, said: “He wasn’t the type to complain. And since he didn’t have insurance …”

Kelly, 45, worked on different jobs with his brother. He was the one who rushed Lonnie to an emergency room one day last fall when the headaches became so severe that Lonnie couldn’t stand up.

It would be great if there were something unusual about this story: A person without health insurance gets sick. The person holds off on going to the doctor because there’s no way to pay the bill. The person is denied the full range of treatment because of the absence of insurance. The person dies.

Lonnie Lynam’s headaches had been caused by cancerous tumors in his brain. During surgery, doctors discovered that the cancer had spread from other parts of his body.

Cancer is no longer the all-but-automatic death sentence that it once was. Extraordinary progress has been made in fighting the myriad forms of the disease.

But, as the American Cancer Society has recently been stressing, the health coverage crisis in the U.S. is a major drag on this fight.

“A woman without health insurance who gets a breast cancer diagnosis is at least 40 percent more likely to die,” said John Seffrin, the cancer society’s chief executive.

According to the cancer society: “Uninsured patients and those on Medicaid are much more likely than those with private health insurance to be diagnosed with cancer in its later stages, when it is more often fatal.”

The uninsured (and underinsured) are also much less likely to get the most effective treatment after the diagnosis is made.

There are 47 million Americans without health insurance and another 17 million with coverage that will not pay for the treatments necessary to fight cancer and other very serious diseases.

The bottom line, said Mr. Seffrin, is that “the number of people who are suffering needlessly from cancer because they don’t have access to quality health care is very large and increasing as I speak.”

Part two of the Lynam family’s nightmare began when Lonnie returned home from the hospital. Lonnie had very little money, so Kelly stepped in and began paying most of his brother’s nonmedical bills.

Betty Lynam flew to Texas as often as she could to be with her son. She said he needed chemotherapy and radiation treatment, but since he couldn’t afford it, he couldn’t always get it.

“He was trying to pay a little bit at a time for the doctors and for the different treatments,” she said. “But he didn’t have a savings account or any collateral, except for his tools.

“I’d ask how he was feeling, and he’d tell me, ‘Well, I didn’t get the treatment today.’ And I’d say, ‘Why?’ And he’d say, ‘Well, I got in there and they found out I didn’t have any insurance and the woman told me I’d have to come back another time because she’d have to check with the doctor or somebody.’

“He suffered a great deal. Yes, he did.”

After awhile, as his condition deteriorated, Lonnie Lynam, carpenter extraordinaire, became all but consumed by the fear of death. Toward the end, he would sleep with a light and the television on, his mother said, “because he wanted to see something or hear something as soon as he woke up to know that he was still alive.”

She said: “Some nights he’d be so frightened he’d come crawl into bed with me and just say, ‘Hold me, mom.’ I just slept right with him in the hospital and just held him, you know?'”

Lonnie died on March 26 at age 45. The cause of death was cancer, aided and abetted by an absurd, unnecessary and utterly unconscionable absence of health insurance.

New York Times
Letters, November 6, 2007

In Such a Rich Land, a Health Care Disgrace

To the Editor:

Re “Worsening the Odds” (column, Nov. 3):

As always, Bob Herbert compellingly illustrates the devastating effects policies have on real people. If only all of those who view themselves as “pro-life” would read his account of Lonnie Lynam’s tragic death, perhaps their advocacy would expand to life beyond birth. That a vibrant and gifted young man should have to die because he can’t afford health insurance in the richest country on earth is immoral and obscene.

Such a shame is a measure of how much those in power in American truly value life.

Mary McGill
Colorado Springs, Nov. 3, 2007

To the Editor:

I commend Bob Herbert for continuing to point out the disgrace that our health care system has become. It is appalling that nearly 20 percent of the United States population is either uninsured or underinsured.

Before my husband and I moved to Denmark in August, we were increasingly frustrated with a system in which even people with “good” insurance spend too much time begging for approval for medical treatments. As a physician, my husband felt he was in a daily fight with midlevel bureaucrats whose sole job was to deny care.

Here in Denmark, taxes are high, but everyone has health coverage (not to mention free university education). Yes, it’s “socializedmedicine,” but it works. How much worse does the American system need to get before it moves to the top of the public agenda? Will we get a workable health care system before or after we bomb Iran?

Emily Clark
Copenhagen, Nov. 3, 2007