Center for American progress unveils universal healthcare plan

Read it here

The problem with this plan is it does nothing to solve the problem that we pay 2X as much per person for healthcare - most of which is in administrative costs - as any other country.

This well-intentioned approach is similar to that of Kerry and others - it covers everybody, but still tosses a huge bone to the insurance companies and other middlemen who want to keep their finger in the pie. A single-payer plan doesn't have that problem - it gives us the common-sense and less expensive system that all other developed nations have, by getting rid of these middlemen.

ALSO, this type of plan preserves the emerging 2-class system in which Medicaid is of much poorer quality than that provided by private insurance or Medicare because those on Medicaid don't have the political power to improve the coverage options. A single-payer plan doesn't have that problem.

On the other hand, I've heard the argument that if you provide the option of medicaid for all those who don't get employer-sponsored insurance, more and more employers will choose to pay the cheaper tax and not provide private insurance. So gradually more people get on Medicaid, which gives the Medicaid lobby more power and improves the quality of medicaid care. This snowballs until everyone's on Medicaid and everyone votes to make it a great system - thus providing a kind-of free-market evolution towards single-payer. My problem with this: if you want single-payer, advocate for it - any plan to "evolve" towards it may leave us with something even worse (again).

Hat tip to ThinkProgress

Emory Prof Promotes Tax Breaks to help Uninsured

from AccessNorthGa:

"An Emory University healthcare economist at the Second Annual Community Healthcare Conference said Monday make health insurance tax deductible for everybody.

Dr. Curtis Florence said at Lanier Technical College nearly 17 million Americans who are self-employed or work for small businesses are without health insurance."

OK, yeah. IF this proposal includes not just deductions but also tax CREDITS then it will help people who can't afford care. Without credits it's useless.
But even with credits, I think it's pretty useless because what people don't understand is that a huge percentage of the uninsured are TURNED DOWN for insurance because of preexisting conditions. Tax breaks don't help with that at all. Today you can get turned down for high blood pressure, cataracts, or depression, or any other of a number of very common conditions. If you have GROUP insurance, it's not a problem. But this guy is proposing individual insurance - which in my opinion is totally worthless because a huge number of people simply cannot buy it no matter how much money they have.

New Commonwealth Fund Study Pans US healthcare

There's a summary of the study in Forbes.com:

Some facts we already know:

The U.S. health-care system is fraught with waste and inefficiency, unequal access, and stubborn gaps in quality and coverage, but it also offers opportunities for improvement, according to a new report.

...

Access to care remains one of the nation's most intractable health-care problems, the report suggested. Some 45.8 million Americans lack health insurance coverage, and that number is projected to exceed 50 million by the end of the decade.

...

Though the U.S. spends more than twice as much on health care per capita as other industrialized nations, Americans don't live as long as people in some industrialized countries.

...

Dr. James J. Mongan, president and CEO of Partners HealthCare in Boston, said that additional taxes or employer mandates will be needed to finance expanded coverage, an idea that is likely to face continued resistance.

"Progress in the struggle to finance universal coverage will not come easily and will be bitterly fought at every step," he wrote. "I believe progress on health insurance will come only when we as a nation answer the question of what happened to social justice as a moral value."

Republican Senators oppose $8.9 billion for HealthCare for Katrina Victims

From The Hill. Of course, $300 billion to establish an Islamic Theocracy in Iraq gets tons of republican support. But $8.9 billion for healthcare for our own citizens hurt by natural disaster? No, that would be wasteful. Note: $8.9 billion is LESS than the amount that Halliburton "cannot account for" in it's Iraq contracts ($9 bill) - in otherwords, we routinely THROW AWAY that amount when it comes to the administration's corporate buddies working in Iraq, but we can't spend it when our people really need it.

Study: Association Health Plans will hurt access to insurance

Interesting Boston Globe Article about a Harvard study which concludes that the new "Association health plans" bill being pushed through Congress will result in LESS access to health insurance, because it will allow group insurers for small businesses to exclude patients with preexisting conditions (ie, those who need it the most).

Nancy Turnbull, a professor at Harvard School of Public Health who co-wrote the study, said the bill would unintentionally hurt employees' access to healthcare because association health plans would keep costs lower by signing up people who are healthy and thus have fewer medical expenses. Those with preexisting medical conditions could be excluded, Turnbull said, leaving them in traditional small-group plans with skyrocketing rates.

She said that would undermine a basic tenet of insurance: Large groups of people help absorb the expense of higher-cost members.

''We have a carefully structured and regulated system for small-group health insurance that's designed to broadly spread costs and prevent insurers from damaging practices such as cherry-picking," said Turnbull, a former official in the state Division of Insurance who helped craft some of the existing regulations.

This is, of course, what insurers have been hoping for ever since the 1990s: a way to override HIPAA and stop insuring sick people when they switch jobs.

Americans dying because cannot access healthcare

from the Louisville, Kentucky Courier-Journal, a pretty scary article about the sad state of healthcare in that state. Some highlights:

People die," May said. "They simply die for lack of health care."

Poverty and a legacy of bad health habits have made Kentucky one of the sickest states in the union. But the crisis is worsened by weaknesses in the state's health-care fabric.

Doctors, clinics and hospitals are in short supply in many rural areas of the state. And many Kentuckians — even in the state's doctor-rich cities — can't afford good and consistent care because they lack insurance or their policies are limited in what they cover. In many cases, they have trouble just getting to a doctor.

Gaps in the health-care system affect such people as Julia Terry and Annetta Vitato.

Terry, 55, of rural Breathitt County in Eastern Kentucky, has no health insurance and earns $269 a month cleaning homes and a church.

She said she hasn't been able to afford to see a doctor, and even if she could, she couldn't pay for any prescriptions for her arthritis and high blood pressure. All she can do, she said, is watch her diet and use Tylenol.

Vitato, 63, of Louisville, regularly goes to the Family Health Centers clinic in Portland for subsidized care because she is unemployed and uninsured.

Yet when her legs swelled dangerously earlier this year, Vitato had to seek hospital treatment because she couldn't get an appointment at the busy clinic on short notice. That left her — and ultimately the hospital and its other customers — with a bill she can never fully pay.

...

Such gaps in care also affect those who do have a doctor, insurance and transportation — they face higher tax and insurance rates to cover those who are without. Plus, crowded emergency rooms lead to delayed care for everyone and greater stress on the staffs.

Said Judy Owens, director of the University of Kentucky Center of Excellence in Rural Health: "The general population who is employed and has insurance, I don't think they quite understand what our safety net is and how many holes there are in it."

Healthcare for All?

Mother Jones has a great listing of a large number of studies - each of which make separate points, but the article concludes that all the points add up to American public support for government funded universal health care of some kind. The studies included have conclusions we've heard before - that Americans are willing to pay higher taxes to reduce # of uninsured, that Americans cite access to or cost of health care as their most pressing concern, etc. But does it all add up to public support for govt care? Read it and see what you think.

New study: Failure of Medicare Drug Program

from Families USA, a study comparing costs of drugs under the new Medicare program to the cost that the VA gets when negotiating bulk purchases from suppliers. Of course, there's not much comparison:

We found that, for the 50 drugs most frequently prescribed to seniors, the lowest Medicare discount card price was almost always considerably higher than the lowest price negotiated by one large government purchaser, the Department of Veterans Affairs (VA). The median difference between the lowest Medicare discount card price and the best price available from the VA was 58.2 percent. This means that, for half of the top 50 drugs prescribed to seniors, the purchase price with a discount card was at least 58.2 percent higher than for those same drugs purchased through the VA.

Great post at KOS about healthcare economics

this post at dailykos.com details a speech by an economist which shows a lot of the pitfalls of our admisitrative-cost-heavy system. It also talks a bit about HSAs - I found this section particularly interesting - he's talking about HSAs:

First of all, it CAN be used to a good purpose. If the employer is putting enough $ in the account and paying the premiums, and the patient is not chronically ill, it can really help the patient out.
But, consider the 80/20 rule: 20% of patients (the chronically ill) use 80% of all healthcare services. These patients would have to pay up to their deductible every single year, which means it would be a huge financial hit for them, even if their employer was contributing. This system would put the worst burden on our sickest patients.
Second, consider a mother of 3 who makes $25k per year at Wal-Mart in Dallas, TX. Wal-Mart doesn't give her healthcare. This was the part of Uwe's talk that made the biggest impression on everyone.
He looked up the plans available to this woman online. There were 2 - one with a ~$120/mo premium and a $10,000 deductible and $5 generic/$10 brand name drug copays, and one with a $160/mo premium and a $5000 deductible.
I unfortunately do not have the numbers in front of me, but he extrapolated out health care costs over the next 10 years using the 2 1/2 % rule (healthcare costs grow at a rate 2 1/2% higher than that of the GDP) and the calculations came out that this woman would have to spend something like 55% of her income on healthcare alone.

Study shows difficulty of getting appointment if uninsured

Good study.The article is unclear about how many providers would schedule an appointment for an unisured patient - it's either half or four-fifths. It is clear that almost all providers required payment in full up front.

Tell that to your friend who complains about uninsured people going to the ER. Again: what choice do they have?

SC Medicaid "Personal Accounts" Plan will Leave Providers Paying

The Savannah Business Report & Journal has a pretty good article about how hospitals in South Carolina are worried that the state's plan for "personal accounts" for medicaid will leave people with no way to pay for care when their accounts run out. The article focuses on the burden this places on providers:

... the State would cap the amount each patient had to spend based on factors such as age, sex, physical condition and health history. If patients run out of money, they must pay out of their own pockets or forego treatment.

Health-care providers in the Palmetto State are crying foul, saying the change would leave many patients without preventive care and force hospitals, which are obligated to provide care whether a patient is insured or not, to foot the bill,
...
'We're willing to support the State in trying to look at providing Medicaid services to these clients, but if and when their maximum amount runs out, they could use those visits and they'll be done in six months,' Gardner said. 'Then we'll continue to treat them and we will bear the brunt of the costs

And this of course will end up costing more in the long run, like most short-sighted "reform" proposals:

But the new system would wind up costing taxpayers more than it saves when Medicaid patients whose accounts have been depleted wind up in the emergency room, Gardner said.

"We can provide more reasonable care on an outpatient basis," Gardner said. "The additional chronically ill patients, if we can't see them on an outpatient basis, they're going to wind up in the hospital anyway."

Dr. Francis Rushton, a physician at Beaufort Pediatrics, said it is important that patients, especially children, have access to primary and preventive care.

"It will end up costing state Medicaid programs less money," Rushton said.

What the article totally misses is the cost, financial and HUMAN, of people choosing between the ER not getting care at all. Sure, it's terrible that the providers, and ultimately the state, will end up paying more for care for those who go to the ER, but what about those who forgo care? Sick kids who miss school? Parents who miss work because they're sick or because their kids are sick? Simple pain and suffering of an untreated wound or infection? AND the fact that untreated illnesses SPREAD.
And even for those who do go to the ER - the only place anyone will treat them without insurance - they miss a whole or half day of work, they are unlikely to get needed follow-up care, AND they will be hounded by collection agencies until their wages are garnished unless they can qualify for bankruptcy.

This is truly becoming more like - or worse than - the third world in terms of healtcare.

Congress Paying MORE to get Insurance companies into Medicaid Biz

This is an article discussing new legislation planning to move PPOs into Medicaid. What I found interesting is the facts about the failure of Medicare Choice options to save money - particularly the revelation that Medicare pays MORE (11.9%) to ensure someone in a Managed Care plan than someone in traditional Medicare.
Why would Congress want to pay MORE money for the same (or worse) service? Could it be related to Insurance companies wanting a piece of the pie??

From Physicians for a National Health Program

DesMoines Register comes out for Single-Payer

As the article says, single-payer is good for business. read it.
DesMoinesRegister.com

JAMA study: Uninsured and those w/ medicaid can't get appointments when NEED them

As reported in Reuters.co.uk:

The same research assistant called each clinic twice using the same scenario but reporting different insurance status - no insurance, private insurance, or Medicaid -- the federal/state program for the poor.
'In our study, the callers who were trying to get appointments had potentially very serious conditions,' Asplin emphasized. 'These were not people trying to get an appointment for a sore throat or a cold. But despite the severity of there conditions, callers still had problems getting appointments when they didn't have the right insurance card.'
'This study, I think, speaks to a really important myth that is out there,' Asplin said. 'That is that a lot of Americans think that, sure we have 45.8 million uninsured people, but when they really need care they get it -- and in our study the uninsured callers really needed care and they weren't able to get it.'
Specifically, 63 percent of callers claiming to have private insurance secured timely follow-up appointments compared with just 34 percent of those who said they had Medicaid.

One scary thing to me about this study is the reluctance to treat those w/ Medicaid. That either means that 1) the Medicaid reimbursement rates are too low for the market; or 2) Medicaid (as administered by the state) has a reputation for not paying or for contesting charges.
If it's #2, then it would be state-dependent. I wonder what state this was. I also wonder if the same results are true for Medicare.

National Governors Association Medicaid proposal will Leave more kids w/o insurance

From Kaisernetwork.org: "Between 500,000 and 1.5 million children would lose health insurance coverage under a National Governors Association proposal to help reduce Medicaid costs"