Dan's Health Policy Alert

Center for American progress unveils universal healthcare plan

2005-10-10T13:43:00.000-05:00

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

2005-10-03T16:59:00.000-05:00

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

2005-10-03T16:44:00.000-05:00

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

2005-10-03T16:31:00.000-05:00

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

2005-10-03T16:26:00.000-05:00

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

2005-09-27T15:27:00.000-05:00

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?

2005-09-27T14:58:00.000-05:00

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

2005-09-27T13:32:00.000-05:00

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

2005-09-24T14:28:00.000-05:00

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

2005-09-24T13:53:00.000-05:00

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

2005-09-20T09:39:00.000-05:00

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

2005-09-14T16:50:00.000-05:00

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

2005-09-14T16:42:00.000-05:00

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

2005-09-14T16:32:00.000-05:00

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

2005-09-13T15:02:00.000-05:00

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"

UN Report US is becoming 3rd World - in part because of Health Care Inequality

2005-09-11T08:40:00.000-05:00

The UN's annual Human Development Report is out, and for the first time considers conditions in the US along with those in the Third World ... because conditions in the US are WORSE than those in the Third World for many people:

The annual Human Development Report normally concerns itself with the Third World, but the 2005 edition scrutinises inequalities in health provision inside the US as part of a survey of how inequality worldwide is retarding the eradication of poverty.
It reveals that the infant mortality rate has been rising in the US for the past five years - and is now the same as Malaysia. America's black children are twice as likely as whites to die before their first birthday.

High levels of spending on personal health care reflect America's cutting-edge medical technology and treatment. But the paradox at the heart of the US health system is that, because of inequalities in health financing, countries that spend substantially less than the US have, on average, a healthier population. A baby boy from one of the top 5 per cent richest families in America will live 25 per cent longer than a boy born in the bottom 5 per cent and the infant mortality rate in the US is the same as Malaysia, which has a quarter of America's income.

Blacks in Washington DC have a higher infant death rate than people in the Indian state of Kerala

...

The US is the only wealthy country with no universal health insurance system. Its mix of employer-based private insurance and public coverage does not reach all Americans. More than one in six people of working age lack insurance. One in three families living below the poverty line are uninsured. Just 13 per cent of white Americans are uninsured, compared with 21 per cent of blacks and 34 per cent of Hispanic Americans. Being born into an uninsured household increases the probability of death before the age of one by about 50 per cent.

... and as the article says in it's header, all these inequalities lead to the "shocking" fact that "Parts of the United States are as poor as the Third World".

Guess it's only shocking if you don't live here.

Hospitals want to take away access to Emergency Care

2005-09-11T08:27:00.000-05:00

This article starts out with the undeniable fact that uninsured people seek care in emergency rooms, which is ridiculously expensive and drives up the overall cost of care.

So what's their solution? Repeal EMTALA, the federal law which requires emergency rooms to evaluate anyone who comes in their doors, regardless of ability to pay.
... And that would leave the uninsured with WHERE to go? Oh, yeah - NOWHERE.

I hear doctors and hospitals complaining about EMTALA and uninsured people going the emergency room all the time. They're right - it's a problem.
But the ROOT of the problem is that there is nowhere ELSE for uninsured to go. NO doctor will take them. NO "urgent care" center will take them. If you cut out the ER, there's nothing.
The ONLY solution is to give the uninsured somewhere else to go to get care. Then they won't choose to go to the ER - who would choose a 4-hour wait surrounded by dying gunshot wound victims and screaming schizophrenics if you have a choice (OK, maybe my local San Francisco General Hospital ER is a little more exciting than most...)

Yes, I realize some insured folks go to ER too unnecessarily. The article mentions "earaches". So here's a scenario: your kid gets an earache on Friday at 5. Your doctor's office won't even take your call until Monday, and then they tell you there are no appointments until Wednesday (at the earliest). So you are supposed to let your kid stay in excrutiating pain for FIVE DAYS, possibly damaging his hearing for life? Really, doctors - tell me, what do you suggest?
BY THE WAY, when we call our doctor's "on call nurse" in this situation, she TELLS us to go to the ER - EVERY TIME.
I'd like the hospital folks to tell us what our options are if not the ER.

California investigating Sutter's tax-exempt status

2005-09-11T08:14:00.000-05:00

Among other things, it looks like Sutter, along with many other supposed 'non-profits', is gouging the uninsured, contrary to their obligation to provide charity care:

from Yahoo

Duty to provide Medical Aid to Spouse

2005-08-26T13:35:00.000-05:00

Interesting post on HealthLawProf Blog, about a new case that for the first time finds a person can be sued for failing to get medical help for his or her spouse:

in Sklarksy v. New Hope Gild Center, 12923/01, a court held that an exception to that rule exists, finding that husband had a duty to provide medical assistance to his wife, whose mental illness left her in a 'diminished, incapacitated and helpless state.'

Doctors leaving US for Canada

2005-08-25T17:15:00.000-05:00

Not sure how much of a connection there is, but apparently more doctors are now leaving the US for Canada... from
The Health Care Blog: "In 2004, 317 physicians returned to Canada and 262 left."

Article Calls for Divorcing HealthCare from Employment

2005-08-25T16:33:00.000-05:00

It's just common sense, folks. Healthcare should not be dependent on employment and shouldn't be dragging down our business competitiveness.
I linked to a PNHP summary of the article because I couldn't find the original article on the newspaper's page: Time for a healthy divorce from employment

This article has some awesome facts - some of my faves:

For the past five years, employee health plan costs in Berkshire County and elsewhere have been rising at double digit rates, and the same is predicted for the coming year. For some small business owners, the rate of rise in health insurance prices has been even steeper.

In 2003, GM’s cost to build a midsize car in the United States included $1,400 for health insurance. However, in Canada, GM was able to manufacture a car for $1,400 less than in the U.S. because Canada has a single payer national health insurance program rather than private insurance tied to employment.

A joint letter signed by the top executives of the Big Three automakers (GM, Ford, and Daimler/ Chrysler) in Canada, said that in addition to providing “essential and affordable health services for all” single payer “significantly reduces total labor costs compared to the cost of equivalent private insurance services purchased by U.S. -based automakers,” and “has been an important ingredient in the success of Canada’s most important export industry (automobiles).”
Canadian national health insurance saved Canadian automakers $4 per hour per worker in 2003 (in U.S. dollars). “High health care costs have created a competitive gap that’s driving investment decisions away from the U.S.,” said the vice chairman at Ford.

... single payer is not socialized medicine, because health care itself would be provided by privately-owned hospitals and doctors’ offices. The only change would be in the funding and administering of health care by a “single payer” (the government), rather than the current hundreds of insurance payers. The government already pays for more than 60 percent of health care, including Medicaid, Medicare, and the Veterans Administration health care system, as well as paying for public employees’ private health care coverage and giving tax subsidies to private insurance companies.

There's even more good stuff in the article
.

Medical Record Privacy Catch-22

2005-08-25T16:02:00.000-05:00

Health business blog points to an interesting catch-22: One law prohibits parents from accessing teens' medical records, but another law prohibits teens from accessing their own records.
This is why health policy is so fun.

Drug Companies Spend $72 Mil to Defeat Collective Purchasing

2005-08-25T15:50:00.000-05:00

California Prop 79 would get cheaper drugs for Cali's residents by negotiating bulk purchase prices with drug companies - the same way Canada and every other halfway smart government does it.
The Drug Companies are spending more money on this campaign than has ever been spent on any ballot campaign anywhere, in an attempt to defeat this common sense plan that will help get needed medicine in the hands of people that currently can't afford it.

The story is at Health Access.

I'm all in favor of promoting research and protecting patents and all that. But if I weigh protecting drug company research funds against getting medicine to someone who will die without it, I choose life.

geotenncare: There has got to be serious, practical and compassionate national health care reforms.

2005-08-23T14:50:00.000-05:00

From the excellent geotenncare blog - a short post linking the failure of yet another medicaid HMO to the overall crisis in American health Care and the need for a national solution.

The Conservative Philosophy Is Anti-Risk-Spreading

2005-08-23T14:46:00.000-05:00

Good summary of a great new yorker article. I'm posting the link to the Healthy Blog summary instead of the link to the New Yorker because this is a great blog and you should read all the posts, including this one:

In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.

The HealthCare Choice Act

2005-08-23T14:41:00.000-05:00

Kevin Drumm in The Washington Monthly agrees with the new republic article which slams the Health Care Choice Act, which would allow purchasing out-of-state insurance, thus obliterating state regulation of insurance - which he argues is exactly the goal of this bill.

As Cohn points out, real choice would require a universal healthcare plan that genuinely allows everyone to choose the doctors and hospitals they like best. The problem, he concludes, is that "Those aren't the kind of choices that conservatives want to give Americans, since they happen to require expanding government. But they're the kind of choices Americans would appreciate most."

The original TNR article requires registration and is here.

PE.com | Inland Southern California | Inland News

2005-08-23T14:25:00.000-05:00

Interesting question: do specialty hospitals (ie heart surgery centers) destabilize healthcare financing by pulling the wealthy away from general hospitals, leaving only the poor and uninsured - as opposed to the current system in which the wealthy partially subsidize the cost of providing indigent care?
read the article here - free registration required

Article Gets it Wrong about Out-of-network hospital Doctors

2005-08-23T14:17:00.000-05:00

This article from the Milwaukee Journal Sentinel perpetuates a common misconception about a common problem.

The problem is real enough: you have a PPO. You go to an "in-network" hospital. But it turns out the doctor that treats you is not "in-network". So the charge for that doctor doesn't get the PPO discount, AND the insurance pays it at a lower rate - leading to a much higher charge for you. Often these charges can run into thousands of dollars for an overnight hospital stay. The article is wrong to say the problem is "not widespread". This is the most common problem I heard about when researching consumer PPO woes.

The article perpetuates the myth that people just have to take this treatment, and discusses a proposed state (I assume Wisconsin) "rule" which would require doctors to join the PPO networks. That's wrong on 2 counts:

1. If an insurance company claims in their materials presented to a participant that the participant can go to a particular hospital for treatment at a particular rate, then ALL charges incurred during that hospital treatment should be paid at that rate by that insurance company. I have successfully fought this issue HUNDREDS of times and won every time. It's a simple case of contract adherence: the PPO PROMISED to pay for "in-patient care" at 100% at contracted hospitals. It's in my plan. It's not my problem if they didn't bother to get the right contracts with the doctors - they have to adhere to their contract with me and pay for 100% of my "inpatient care" at that hospital.

2. The state does not need to further burden doctors. Instead, they should go after the problem: insurance companies not abiding by their contracts. Maybe the reason I succeeded at fighting these in the past is that California, where I lived then, had stricter rules about this - I don't know for sure. But if that's the case than other states should do the same.

In any case, if I pay for insurance that promises to pay "100% of inpatient costs" at "in-network hospitals", and if I go to an in-network hospital, the INSURANCE company should abide by their promise and pay the doctors - contract or not.

Another article about US Employers sending Employees to Mexico

2005-08-23T13:01:00.000-05:00

Similar to my earlier post - another sad tale of how US employers can only find affordable health care by turning to a country that can apparently do it way better than the US (comparable quality at 40%-50% of the cost)

Healthcare Is Migrating South of the Border - Los Angeles Times

US Employers Turning to MEXICO for Affordable Health Care

2005-08-23T12:54:00.000-05:00

Pretty sad when employers in the US have to start sending workers
across the border for health care, because our country can't provide affordable health care.

Good Article about the Health Crisis

2005-08-23T12:49:00.000-05:00

From the
SF Chronicle

Insurers settling suits for swindling doctors

2005-08-18T16:27:00.000-05:00

Fro law.com:

The insurers, according to the suit, swindled the doctors by systematically and fraudulently cutting their bills. Health plans rely on software to process hundreds of millions of claims a year. Each claim carries some combination of 8,000 five-digit codes to describe individual procedures. Ten leading managed care companies, the lawsuit says, rigged this software to automatically ignore some codes and change others to reflect less costly procedures. They then counted on doctors' offices being too overwhelmed or perplexed to appeal. (Not so Abidin. The doctor did appeal -- twice -- before United Health paid him for the throat exam.) "

So far they've settled with Aetna, Cigna, Health Net, Prudential, Anthem, and Wellpoint, for over $1billion total, and still pursuing others. That's some major swindlin'.

WSJ Opinion FALSELY claims unique Colorado program shows "patient empowerment" works

2005-08-18T12:31:00.000-05:00

Kaiser reports here on a subscription-only article in the Wall Street Journal, in which John Andrews from the "Claremont Institute" claims that a unique program in Colorado is showing that "patient-empowerment" saves money and helps patients. The problem is: the program is not unique, and it doesn't show anything about what others call "patient-empowerment."

The colorado program allows medicaid beneficiaries to choose their own home health care workers, instead of going through state-approved middlemen who choose the workers for you. They say it's saved 21% and gets patients better care.

Problems:
1. the article claims that this is unique and groundbreaking. "Andrews says that Colorado legislators have approved offering the consumer-directed Medicaid plan to 33,000 Medicaid beneficiaries statewide in 2006, but "patient-empowerment initiatives in Medicaid" still remain relatively unknown in other states."

BUT in fact, here in Minnesota we have the EXACT same program, ALREADY extended to ALL recipients as of 3 years ago. They had a pilot for over 5 years before that. Here it's called "consumer-directed community support" - in which you can plan ALL of your purchases (other than traditional medical care) yourself after getting a lump grant of cash. Or, on the more limited program that's just like Colorado's, it's called "Consumer choice PCA option". Colorado's plan is called the "Consumer-Directed Attendant Support program".

Could Mr. Andrews not bother to do basic research to find out that other states have operated the same program for 8 years, and see how they worked, rather than trumpeting a 1-year-old program that was only a PILOT? Makes you wonder if he really knows anything about this area.

2. The article uses the success of this as a springboard to argue for more support for "patient-empowerment initiatives in Medicaid", which he CONTRASTS with "universal healthcare," saying that the consumer-directed movement is gaining ground, while "universal healthcare" is losing support. What??
The consumer-directed approach of grants to individuals to purchase their care does not affect coverage at all. If anything it increases the number insured, by reducing costs. As an advocate of "universal health care", I think THIS type of consumer-directed care is great. Note that this type of care has ZERO effect on the Medicaid insurance people use to go to the doctor - if you go, you're still covered, regardless of whether you've "used up" your cash allotment for the consumer-directed stuff.
It is true that you could use up your allotment for your home care attendant in 6 months and then have no home care. But home care is ALWAYS a time-limited allocation. You get x hours per day in traditional Medicaid, vs x hours per year with consumer directed. Time-limited either way. VERSUS doctor care or hospital visits, which IS NOT (and should not) be time-limited. With insurance (And Medicaid), you can go to the doctor as much as you need, and stay in the hospital as long as you need.
Colorado's plan has nothing in common with plans like South Carolina's to give individuals block grants to buy medical care. The S.C. plan will drastically REDUCE care for individuals and leave many with NO WAY to pay for DOCTORS after their cash runs out - leaving people sick and dying without care. That's because it changes that promise of "as much doctor care as you NEED" into a promise of "$2,000 worth of care and then you're screwed."

This article attempts to equate a smart, useful program that removes useless middlemen in the purchase of time-limited services with inefficient programs like South Carolinas which ADD middle-men and put limits on care that was previously limited only by need. It's a false comparison - don't buy it.

sSC Medicaid Proposal: Just adding more layers of administration

2005-08-17T17:05:00.000-05:00

South Carolina has a proposal for redefining Medicaid which is getting a lot of press. Read a few articles and blogs on it today. Key issue seems to be that they will replace government insurance with payments directly to individuals, with which they can purchase care directly OR purchase insurance.

Best short overview is from
SF Gate.

A good critique at the excellent Health Care Blog mentions the key issue - that

in order to qualify for Medicaid (2003 numbers), a mom in a family of three has to earn less than $7,510 a year. Disabled and blind folks have to earn less than $12,120 ($9k if they're single). The old folks can pull down a cool $16,362, and kids can be covered even if their family of 3 is rolling in cash--up to $22,890

This critique is mainly worried about people who use the cash to purchase care directly - not to purchase insurance - and then run out. That is a major problem.

There is a comprehensive description of the plan and a detailed critique of its faulty assumptions at the Center on Budget and Policy Priorities. You should read this if you care about the issue. But here are the main points that resonate with me:

1. The state will give money to people based on a prediction of how much they'll need. What if they need more? If they actually get sick? Answer: they're screwed. In some cases, they will die. A kid who gets $1,000 per year, and whose parents choose the state-suggested "self-directed care" plan, will simply be out of luck if he suddenly needs heart surgery. Or diabetes drugs. Or asthma medication. Or anything that costs more than $1,000 per year.
The whole point of insurance is to spread risk. The SC plan takes that away by advocating that individuals forgo insurance and simply pay directly for care out of a fixed lump of cash they get every year.

2. EPSDT requirements for kids are eliminated in the SC plan. These "Early and Periodic Screening, Diagnosis and Treatment" services are required by all other state medicaid plans. They pay for all kinds of things - for kids only - that other insurance doesn't pay for. Hearing screening. Testing to see if someone's developmentally disabled. Wheelchairs. Hearing aids. Physical therapy for non-rehabilitative purposes. (PT is usually only covered for "rehabilitation" under insurance policies - only to recover to the point of pre-injury function - not to gain function you never had, as is needed for children with Cerebral Palsy and other physical conditions.)

3. The SC proposal assumes that private insurance is more efficient that medicaid. Tons of studies show that the opposite is true.

A recent 13-state study contradicts the notion that Medicaid beneficiaries use more health care than they need, finding instead that adult Medicaid beneficiaries use about the same level of health care services as adults with private insurance.[4] A study of mothers in low-income families found similar results.[5]
...
Moreover, Medicaid is not costlier than private health insurance. A recent study by Urban Institute researchers for the Kaiser Family Foundation found that Medicaid’s cost per beneficiary is lower than that of private insurance.[7] A separate study by Urban Institute researchers finds that Medicaid’s per-beneficiary costs have been rising more slowly than those of private insurance in recent years.[8]

The two principal reasons why Medicaid costs less than private health insurance are that its payment rates to providers tend to be lower than the rates that private insurance plans pay, and its administrative costs are about half those of private plans. According to estimates by the Centers for Medicare and Medicaid Services, Medicaid’s administrative costs average 6.9 percent of total program costs, while the administrative costs of private health plans average 13.9 percent.

This is especially true for the SC plan, which INCREASES administrative costs considerably. Just think about it. Today, you have one party (the State) providing payments directly to doctors. Under the plan, you have one party (gov) providing payments under 3 different plans to a second party (consumers), who then choose (after advertising and other cost-sucking market measures) another party to insure them (insurers) who then make payments to providers. Just money going through 4 hands instead of 2 increases costs a lot. As the study said:

It should be noted that administrative expenses would rise under the proposed waiver. South Carolina would have to hire a company to counsel beneficiaries on their coverage options, as well as a company to oversee the medical home networks. Also, each private insurance plan would have to set up and maintain its own administrative structure. As the amount of funding going for administration increased, the amount available for actual health care services would decrease. This could put further pressure on provider payment rates that are already low and could thereby affect the willingness of providers to participate in the program.

Luckily, this plan is still in development. Although I think the private accounts is a good way to pour money down the toilet, that part is probably a done deal. If they retain the private accounts, here's what they should do:
A. Get rid of the "self-directed care" option. That option allows people to spend money directly on care and not buy insurance. It stops spreading of risk. People in that option will get sick and have no coverage. And also, people will only go into that option if they are generally healthy, thus increasing the overall risk in the other options, and increasing insurance costs. Just provide money only for purchase of insurance plans, and that problem goes away.
B. Put EPSTD back in. Just cover it the old way, or require plans to cover it. Without this, kids who need it most will really suffer. Politically, it will end up looking like the current administration just screwed over kids. And legally, since Medicaid clearly requires EPSTD, even if the feds approve this plan, it will be the subject of lawsuits that have a good chance of winning.

HMO Prices up 12.6% in 2006, 80% over 6 years

2005-08-16T13:11:00.000-05:00

from Kaiser

NY Times Exposes HSA "Pitfalls"

2005-08-16T09:54:00.000-05:00

Good overview for those wanting to understand what an HSA is and why it's a scam:

The Promise and the Pitfalls of Health Savings Accounts - New York Times:

Some highlights:

Critics also contend that the accounts are basically a tax-shelter gimmick for people who are healthy and wealthy enough to invest in them but don't have to rely on them to cover their care costs.

The article has a good discussion on fees which turn this into a pretty lame "savings" account:

Some people are discovering downsides to the accounts. Ric Joyner, president of the National Association of Professional Benefits Administrators, says he has received frequent calls from companies and individuals interested in setting up the accounts. But lately, Mr. Joyner, who is also president of eflexgroup.com, a benefits administration company in Madison, Wis., says he has been getting calls from people complaining that their account balances are shrinking even though they have not used the money.

"The money they're setting aside for health care is being eaten up by fees," he said.
...
"Unless employers are putting a bunch of money in, I really don't see how these balances are going to get much bigger," said Gary Claxton, vice president of the Kaiser Family Foundation, a health care research and education company in Menlo Park, Calif.

And looks like HSAs are getting even worse, in respect to prescriptions:
Prescription drug coverage poses a problem for many people who are considering whether to open health savings accounts. Starting in January, many prescription drug expenses in qualified plans will be subject to the deductible. Now, consumers typically pay only a portion of the drug costs from the outset.

Mr. Joyner said the idea of paying more out of pocket for prescription drugs made his employees reject the idea of health savings accounts. "They didn't like it that there wasn't going to be a drug card," he said.

I discussed more of the myths and truths about HSAs in an earlier post.

Conservative Columnist Contrasts Care for his Mom with the Uninsured

2005-08-15T13:07:00.000-05:00

I like this because it's a personal story. This self-avowed conservative, upon seeing the expensive care his mother needs following open heart surgery, believes we should be able to spend money to help those who cannot afford health care:

In looking at the big picture of health care, one thing I do not understand. Why is there not enough money to help the working poor with public health care and to keep premiums down for workers on private plans, yet there has been plenty of cash in the industry to make Gov. Phil Bredesen and Dr. Bill Frist into megamillionaires? An elite minority have used our health-care system to get richer and more influential.
...
The entire system, both public and private, is not serving the people but the profiteers who rationalize that letting people die and suffer is the correct CEO-way of looking at health care. The TennCare special session can be a start on this needed examination.
Mom and I differ politically. But I find her digs at President Bush humorous even if I can't agree with them. For conservatives, let them not forget that government is just not about the bottom line. It is about the kind of values -- particularly religious ones -- we feel the president has brought to this nation.Those values unmistakably call on us to love and help our neighbors. Surely, if we can support the spending of more than $200 billion on people we don't know in Iraq, we can summon compassion and the funds for the lives of people we sit next to in church on Sunday.
Mom is going to make it because she has health-care coverage. So many others who have been cut from TennCare will not. In an intensive-care unit, the fight for life is frantic but built upon the truth that every human being is worth saving. The same value should apply in the public policy of state government and in keeping ailing Tennesseans on TennCare, not cutting them off.

I just wish more conservatives would realize that providing for the least well-off is not contrary to our national values of individual self-reliance, but is simple economic and moral sense. Unfortunately -- as in the case of conservatives who only support disability rights when they have a disabled family member, or only support immigrant rights when their relative marries an immigrant, or who suddenly recognize the validity of gay relationships when their daughter comes out -- a lot of people only get the point when it happens to them.

Thanks to GeoTennCare blog for the pointer.

Personal Story: Elderly Can't pay for medications.

2005-08-15T12:58:00.000-05:00

A personal story demonstrating the position of elderly people dropped from the insurance rolls in Tenessee. A 78-year-old man totally unable to buy the medications that keep him alive. He has 2 days left of meds. Then what is he supposed to do?

From GeoTennCare blog

Courts making medicaid rights unenforceable

2005-08-15T11:17:00.000-05:00

Great article in the NYT, describing how courts have limited the right to sue to get Medicaid benefits that are supposedly guaranteed by federal law.

The article doesn't do such a great job of describing the key legal issue, so I'll try:
Federal statutes can generally only be enforced if there is some enforcement mechanism in the law. For instance, some statutes specifically state that if the statutes is violated, a specific person victimized by the violation can sue for a specific kind of damages. I can't think of an example off the top of my head, but imagine a criminal law prohibiting robbery which in addition to criminal penalties, specified that the victim could sue the perpetrator to recover the amount stolen, plus "punitive damages."
Statutes that require government action or inaction and which do not contain explicit enforcement mechanisms can sometimes be enforced under 42 USC 1983. That section specifies a right to sue the government for the violation of a right guaranteed by law:

Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State or Territory or the District of Columbia, subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured in an action at law, suit in equity, or other proper proceeding for redress ...

So, if a state law says, for instance, that people of one race cannot sit in the front of the bus, a person of that race who was forced to sit in the back of the bus could sue the state for deprivation if his or her right to equal protection of the laws under the 15th Amendment.
But the question is: what is a "right, privilege or immunity secured by the Constitutiona and laws"? The NYT article describes how the Supremes have recently limited what statutes create a right enforceable under 1983 to statutes where Congress "unambiguously intended" to create such a right.

As the article describes, the right to medical care created by Medicaid used to be considered enforceable under 1983. Now courts are holding that it is not:

In a typical case, the United States Court of Appeals for the Ninth Circuit, in San Francisco, said this month that Medicaid recipients could not enforce the provision of the Medicaid law that promises them 'equal access' to care and services. In establishing this guarantee, the court said, 'Congress did not unambiguously create an individually enforceable right.'
It is not enough for Medicaid recipients to show 'merely a violation of federal law or the denial of a benefit,' the court said. In addition, it said, plaintiffs must show that Congress clearly intended to allow individuals to go to court to enforce the law.
In the California case, Sanchez v. Johnson, the court found no evidence of such intent.
Sara Rosenbaum, a professor of health law and policy at George Washington University, said: 'The idea of Medicaid as an enforceable entitlement is hanging by a thread. Some of Medicaid's most important provisions cannot be enforced. Increasingly, the courts are saying, 'Don't come to us any more unless you can show that you have an absolutely crystal-clear right.'

The problem with this is, of course, that it makes the statute useless. Isn't the role of the courts to ensure that laws are followed? The Medicaid law unambiguously states that in exchange for a huge pile of federal money, States agree to provide medicaid-eligible people with medically necessary care. It's like a contract. But now if the states refuse to provide that care, they can still take the money? I guess, actually, the US Attorney General could sue the state for failure to follow the law. That actually makes sense, but it is a lot more effective enforcement mechanism if individuals are allowed to sue.

Questionable Studies Push HSA "successes"

2005-08-12T15:44:00.000-05:00

The "Galen Institute" is pushing a study
here
that claims that

Consumerism is working in the health
sector, with a number of studies
showing that companies and
individuals who move to Health Savings
Accounts and similar plans experience lower
costs while maintaining access to needed
health care.

I have no problem with HSA's. I just don't like the way they are sold as "insurance" or as an alternative to insurance. An HSA is a tax-free savings plan. Period. It does NOT pay anything FOR you. It is YOUR money you're spending. I can't stand when people tell me how great it is that they can roll over the money at the end of the year. I say "you mean your employer is letting you keep your own money? How amazing!"
When a company takes away insurance and gives you an HSA, they're basically saying: "now you can pay for your health care with your own money". How is that a better deal than insurance?

(Yes, I know that SOME employers contribute to the HSA account. They consider that part of your wages and so should you. It's still your money.)

Here are my specific problems with the studies in this article:

1. Every study is performed by a company that SELLS HSA's. Not exactly objective. And most of the companies are smaller outfits trying desparately to find a product that will steer small businesses away from traditional carriers so they can grow their own business (for instance, that's e-healthinsurance.com's entire business strategy, and they did one of the main studies quoted here). So there is a huge incentive to make HSA's look good for these companies. If e-healthinsurance.com can convince small businesses that HSA's are good ideas, they can sell more HSA's to companies who currently deal with the big brokers or directly with the big boys (Cigna, BlueCross, etc.)

2. The studies claim that HSA's "save costs" for companies. Well of course they do! They cause employees to spend their own money on care. It's the EMPLOYEE'S money that's in that account. It's deducted from their paycheck.

3. The studies tout the "benefit" of "flexibility" for employees using HSA's as opposed to traditional insurance. Well, again, of course it should be flexible: it's MY money! I should be able to use it however I want! And note: it shouldn't be an amazing benefit to be able to use your health plan to see a specialist you need to see - the problem is that insurance DOESN'T allow that.

4. The studies rave about how the "critics were wrong", and HSA's are not just attractive to the rich - poor people are purchasing them too. The main stat is "40% of HSA-eligble plan purchasers earned $50,000 or less annually."
Now, a "HSA-eligible plan" refers to a high-deductible insurance plan which is paired with an HSA. These plans are way cheaper than lower deductible plan, for the obvious reason that they are terrible plans because they only pay out after you spend a lot (I think $2000, but maybe $1000) of your own money. SO: they are surprised that POOR people are purchasing CHEAP insurance? Wow, what a shocker.

5. They make a lot of claims about increase in preventative care among HSA users, and even quote participants who supposedly chose to start taking care of themselves because, for the first time, they realized it would save them money.
Maybe this is true, but I find it incredible. This is claiming that people are motivated by cost savings of a MAXIMUM of $2,000 / yr (max of HSA $) - assuming that through healthy living they can drive their utilization to ZERO. Where the same people were NEVER motivated by a desire to: live longer, feel better, avoid debilitating pain of heart attacks, stroke, liver failure, etc.
It just doesn't add up. I want to talk to one of these people. Note: the study doesn't say what types of preventative care and how these folks are going to save all this money.

The article does have interesting, but conflicting, information about the affect on utilization. Most data on this is from the Aetna study. It claims that HSA's preserve "access to needed health care", but cites "lower use of inpatient, laboratory, and primary-care hysician visits." It claims "Health measurements were stable for members with chronic conditions" without defining "stable". It says "those with chronic conditions, such as diabetics, continued to seek necessary care."
The most interesting finding, to me, is that members were "much more likely to visit an urgent care center than a hospital room." They cite this as an example of how HSA's cause consumers to make more cost-conscious treatment decisions.
That's BS. Anybody would want to go to an urgent care center more than an emergency room. It's faster, cleaner, and friendlier. Regardless of the cost. BUT many insurance companies don't CONTRACT with urgent care centers. So you CAN'T use them if you have insurance, but you CAN if you have an HSA. That is probably the reason for the change, and it has nothing to do with "cost-consciousness."

Overall, the entire idea that people are out there getting lots of extra health care because it's fun and they don't understand the cost is just stupid. Who does that? Find me somebody who's getting chemo for kicks, or enjoys waiting in line at the emergency room while missing a day of work. It doesn't happen.

The U.S. Auto Industry's Last Hope: Single-Payer

2005-08-11T16:21:00.000-05:00

This article argues that the U.S. Auto industry cannot ompete with foreign manufacturers because we pay so much more in health costs, particularly administrative costs.

GM announced on March 16 that it would report an $850 million loss for the first quarter of 2005 and earn $1 to $2 per share for the year, down from its earlier forecast of $4 to $5 per share. The company's cash flow is a negative $2 billion. GM's bonds now are rated just above junk, and it still owes billions to its underfunded pension and retiree health plans.
Ford cut its profit forecast for the year by 14 percent on April 8 and announced that it will not meet its 2006 goal of $7 billion in pretax profit. Ratings agencies are now poised to downgrade Ford's credit too.

GM paid out $5.2 billion for health care benefits in 2004 and expects to pay out $5.8 billion this year.
...
The costs have been exacerbated by the unwillingness of the Bush administration and Congress to address the catastrophic rise of health care costs in the United States. GM’s $73 billion liability for retiree health benefits could be covered three times over by the amount the United States squanders every year on administrative costs for its private health care system.

China and India will begin exporting cars to the United States within the next few years. Carmakers in both countries benefit from national health care systems that pay for employee benefits with public funds.

The U.S. automakers are moving more production to Canada where a national health care program provides coverage for workers and their families for less than one-fifth of the cost of health benefits on the U.S. side of the border.

Benefit costs account for 28.8 percent of compensation costs for private sector production workers in the United States, compared with 17.0 percent in Japan, 16.6 percent in Canada and 17.6 percent in the United Kingdom. Three-fourths of the difference in benefit costs stems from the private health insurance system in the United States

The Bush administration has a choice. It can preside over the dissolution of what remains of the U.S. auto industry or it can take the first steps toward a national solution for the health care cost crisis that is distorting labor markets, driving down disposable income, leaving millions of Americans without health care and creating the largest competitive disadvantage that U.S. companies now face.

And of course this applies equally to every other industry. Why doesn't big business wake up and push for single-payer??

WSJ: Pharmacy Benefit Managers Charging Undisclosed Markups

2005-08-11T10:58:00.000-05:00

The Procare blog is an interesting one, doctors fighting for better reimbursement from the state. They have a summary today of a Wall Street Journal article
which talks about the fact that PBMs can charge basically whatever they want for drugs.

(PBMs are the way most managed care enrollees get drugs. For instance, when I had drug coverage through Cigna, my Cigna card said "RxPrime Drug Coverage". RxPrime was the PBM.)

Since from what I've heard there are only 3 or 4 PBMs that control the whole market, and since these markups are totally undisclosed, I wonder what the chances are that there is no price fixing going on? No, I'm sure they wouldn't do that - industry would never collaborate to drive prices up to create unrealistic margins at the detriment to consumers :) I was in California when Enron and everyone was artificially creating energy shortages leading to overcharges of $12Bil, so I know it can happen. Wonder if it's happening here.

Think tanks blast S.C. Medicaid plan

2005-08-11T10:39:00.000-05:00

From South Carolina's "The State" newspaper, an article summarizing two recent studis of S.C.'s plan to drastically reduce spending on Medicaid

"The governor's proposal puts children's health at risk, and it imposes substantial new costs on South Carolina's most vulnerable children, which will impede their ability to get needed health care," said Joan Alker, senior researcher at Georgetown's Public Policy Institute.
The proposal, as written, is the most radical and far-reaching waiver in the country submitted to date, Alker said. "It is based on untested concepts that have the potential to unravel the health care safety net in South Carolina."
Kerr said his proposal, which has touched off a firestorm of criticism in South Carolina, was designed to give Medicaid beneficiaries a sense of responsibility and more choice in their health care decisions.
The waiver asks to install co-pays of $100 for inpatient hospital visits and $25 for outpatient surgery.
Critics say Medicaid beneficiaries, who must make less than $2,000 a month for a family of three, can least afford co-pays as a percentage of their incomes.

The article mentions that the state is still claiming that no services for children will be cut, although the studies show that services for all children will be cut. Thanks to geotenncare blog for the pointer.

Good overview of the Status of TennCare

2005-08-11T10:23:00.000-05:00

Kaiser has a good
summary of the recent happenings in TennCare.

For those not following it, TennCare is Tennessee's Medicaid program. Some reports have called it "the most generous in the nation" although I haven't seen any substantiation of that. This year Tenessee is drastically reducing the number of people covered and the services covered. For example, the new TennCare limits (for at least some recipients) you to 5 prescription drugs per month. That's enough for me, but I know it's not sufficient for the most medically needy. Why push a policy that obviously only impacts the most medically needy, and deprives them of services? Wouldn't it be better to reduce services for those who need them less?

Activists have camped out at the capitol for (a long time - a month? two?) to try to force Gov. Bredesen to veto the changes.

This Kaiser report talks about the 97,000 people I keep hearing about, the "most vulnerable" and how a compromise has been reached to modify a consent decree, thus allowing further reductions in care, in exchange for the governor keeping some part of the 97,000 on the rolls.

The Nashville city paper has a good argument about why actually most of those 97,000 won't be staying on the rolls:

The new program, Johnson said, changes the time limit the 97,000 have to present unpaid medical bills to prove they are eligible.

Previously, an enrollee could show old bills to the Department of Human Services for as long as they owed money on them, Johnson said. On the new program, you have to have a medical bill within the last 90 days to remain eligible.

In addition, that bill has to be high enough to reduce their income enough to qualify as being most medically needy, she said.

“If you wanted to keep the 97,000, you would keep the eligibility requirements where they are today,” Johnson said. “They’ve intentionally designed it that only lets a small minority of the 97,000 on.”

Medical Bills Land Millions in Debt

2005-08-10T11:53:00.000-05:00

From The Commonwealth Fund:
"77 million Americans age 19 and older--nearly two of five (37%) adults--have difficulty paying medical bills, have accrued medical debt, or both."

Tenet Agrees to Charge Uninsured moe Fairly

2005-08-10T11:50:00.000-05:00

Kaiser reports on a settlement of one of the defendants in a nationwide series of class-actions regarding hospitals overcharging uninsured patients. As part of the settlement Tenet Healthcare hospitals will now charge uninsured patients the same discounted rates they charge managed care providers.

U.S. health care system is unfair and inefficient

2005-08-09T21:05:00.000-05:00

From the "Times Herald-Record" in upstate NY, a good summary of arguments for single-payer, including a comparison to the Canadian system. Some highlights:

We expend twice as much per capita as other industrialized countries, with poorer health outcomes, such as life expectancies and infant mortality.
...
In the past, Medicare was able to deliver its services with a less than 3 percent overhead, as compared to our 'free market' for profit system with its overhead of 15 to 30 percent. In passing [The recently enacted Medicare Modernization Act] in a most dubious fashion and claiming at the time of passage that it would cost less than $400 billion over 10 years, its now estimated to cost over $800 billion and now with the intention of passing the cost of this 'benefit' to the states.

We would do well to implement a "Medicare for all" system and curb the parasitic insurance and drug industries and their corrupting influence and rid ourselves of those "compliant" legislators. We have the technology and the resources, but our health delivery system is exploited, distorted, unfair and very inefficient. Let's wise up.

Amen.

Health Insurance PROFITS are driving premium costs

2005-08-09T15:51:00.000-05:00

Insurers try to blame rising rates on rising medical costs - but obviously some of the blame must be put on their rising profits.

from bizjournals.com:

Profits for the nation's health maintenance organizations increased a healthy 10.7 percent last year ...
The results, from Weiss Ratings follow a more than 80 percent increase for the HMO industry in 2003.

The story hilites some particular "success" stories:
Humana Medical: 167.8% earnings increase in 2004
Highmark: 1,720.6% earnings increase in 2004
Blue Cross of California: 43.3% earnings increase in 2004
Blue Cross of Oregorn: 158.1% earnings increase in 2004
Capiral Advantage Insurance Co.: 137.9% earnings increase in 2004

Debate Over Wal-Mart Health Benefits

2005-08-09T15:35:00.000-05:00

from Kaisernetwork.org, a great overview of 2 stories about activists taking on WalMart, especially its dismal employee health plan.

"the Wal-Mart health plan, which includes high deductibles and other requirements that have forced some employees to enroll in Medicaid and other public health insurance programs, represents one of the 'most controversial issues' in the debate. Several state legislatures have considered bills that would force companies with more than 10,000 employees to spend 8% of their payroll on health care. However, Ray Bracy, vice president of federal and international affairs at Wal-Mart, said that such legislation unfairly targets the company, adding that Wal-Mart has helped remove individuals from public health insurance programs. Bracy attributed the concerns about the Wal-Mart health plan to a 'broken' employer-sponsored health care system"

Well, he's right about the "broken employer-sponsored health-care system." Does that mean WalMart is going to stand up for single-payer? Actually, I've long thought that all these big companies should start using their clout to push single-payer. They need to get healthcare off their books, and this is the best way. They could increase their taxes by $3,000 / employee and reduce their healthcare by $4,000 with the California Health Care Options Project single-payer proposals.

NYT: Other Countries pay far less and get better care

2005-08-08T12:18:00.000-05:00

This is another excellent subscription-only NYT article, but the abstract (which you can read for free here) gives the gist:

countries that have something to teach US on health care are not those that pinch pennies like Britain but nations like France, Germany and Canada, which offer good care but still spend far less than US; notes that in 2002 US spent $5,267 per person on health care, 45 percent of which was from government funds, compared with $2,931 in Canada and $2,736 in France, mostly from public money; points out that US health care is thus so expensive that government spends more than governments of other advanced countries, even though private sector pays far higher share of bills than anywhere else; links doctor salaries and drug prices.

And from the article:

What do we get for all that money? Not much.
Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries.
...
Why is the price of U.S. health care so high? One answer is doctors' salaries: although average wages in France and the United States are similar, American doctors are paid much more than their French counterparts. Another answer is that America's health care system drives a poor bargain with the pharmaceutical industry.
Above all, a large part of America's health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.

Great Internet Political Campaign shows BlueCross greed

2005-08-08T10:13:00.000-05:00

Another great example of using the internet in grass-roots politics -- for a great cause. If you still think healthcare costs are rising because of old ladies going to the doctor too often, why is it that North Carolina BlueCross is spending half a million dollars to host a golf game?

In the North Carolina NewsObserver.com

California Insurance Commissioner: System on Verge of Collapse

2005-08-08T09:30:00.000-05:00

John Garamendi, California's Insurance Commissioner, issued a report 8/3 on the State's health care system. He said it's "well on its way to collapse," and he blames the problem on outrageous administrative costs and "skeletal" policies like Healthcare Savings Accounts which reduce financial cost but hurt individuals' health and hurt the stability of the system.

NYT: Modern Genetics Makes Single-Payer Inevitable

2005-08-06T12:12:00.000-05:00

Very interesting argument. The idea is that private insurance is based on pooling risk between fragmented groups, and excluding pre-existing conditions. But when genetic science can predict disease predilection accurately, that pooling no longer makes sense, and most diseases become "pre-existing", so the private model goes away and only a national pool will work economically. (In my opinion only a national pool works economically regardless of genetics...) -- This is a subscription-only nytimes article by Robin Cook, but I've experpted some of it below.

Decoding Health Insurance:

In this dawning era of genomic medicine, the result may be that the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete since risk cannot be pooled if it can be determined for individual policyholders. Genetically determined predilection for disease will become the modern equivalent of the ''pre-existing condition'' that private insurers have stringently avoided.
...
But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I'd advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I've changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual's confidential, genetic makeup.

Good WaPo editorial about the health care crisis

2005-08-06T11:58:00.000-05:00

Fix Health Care First (washingtonpost.com):

The tax increase needed to keep Social Security solvent for 75 years is of the same size as the likely growth in health care costs (above per capita gross domestic product) in the next 48 months.

...

Others have made the point that the Medicare trust fund is in far more fragile condition than Social Security and is in need of more rapid rescue. The decision to add a prescription drug benefit to Medicare, starting next year, did not solve the problem; it made it worse.
But it is more than Medicare that is spinning out of control. The Medicaid program, which pays for indigents and for long-term care, is bankrupting state budgets. Overall, Americans are paying more for health care than the people of any other advanced industrial nation -- and reaping fewer benefits, at least as measured by life-span statistics.

Prison Health Care Privatization is Killing People

2005-08-06T11:55:00.000-05:00

The HealthLawProf Blog has a great summary of a NYT article about a few sad cases, but also (at the bottom) links to 4 other stories.
My favorite: Harsh Medicine: As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence (February 27, 2005)

So, there are laws about this stuff. First, this couldn't this be cruel and unusual punishment (8th Amd violation)? If you're sentenced to 30 days and end up dying as a direct result of your mprisonment? Also, there is a "Civil Rights of Institutionalized Persons Act," which can be used to get healthcare for prisoners. But this is a pretty unsympathetic group to lobby for, and a lot of people have the attitude: why should we give prisoners free care if regular people don't get it? Kind of begs the question doesn't it?

How cuts in Medicaid are hurting real people

2005-08-06T11:15:00.000-05:00

Yahoo has a good overview.

Some highlights:

Because of new state Medicaid cutbacks that took effect on July 1, the 62-year-old Missouri woman wasn't sure how she would get the $600 worth of prescription pills and insulin she takes monthly to combat diabetes and high blood pressure.

Foster stopped work a few years ago to adopt her drug-addicted son's two toddlers and the three of them now live on about $1,100 a month with no private insurance.

So as the two children played at her feet, Foster called social workers and hospitals, searching for low-cost access to the medicine she needs. Someone suggested she ask a pharmaceutical company for free samples. That might get her through another month, she was told.

"I've got these children to raise and I don't know what I'm going to do," Foster said, starting to cry. "There isn't much anywhere to turn to."

...

Missouri's cuts are considered by many policy experts to be among the most severe in the nation. The cuts took effect July 1, and are aimed at saving some $230 million for the state, which typically spends about $2 billion on Medicaid annually.

Disabled individuals are losing coverage for crutches, walkers and batteries for their wheelchairs. Occupational, speech and physical therapy are eliminated. Hearing aids and glasses are no longer covered. Under the new standards, a single mother of two children is ineligible for medical benefits if she makes more than $350 a month.

In Tennessee, the state's is trying to cut benefits for up to 290,000 enrollees. Angry Medicaid recipients have spent weeks camping outside the governor's office, some tethered to breathing machines and wheelchairs.

And Pennsylvania legislators last month generated outrage when they cut Medicaid services for children with autism, cerebral palsy and other disabilities as part of a $240 million reduction in Medicaid spending.

...

A national survey released in June by the Kaiser Family Foundation found that 74 percent of Americans somewhat or strongly oppose Medicaid cutbacks.

Critics of the changes say that states need to weed out fraud and find other ways to save money that don't jeopardize the life and health of the most vulnerable people.

Kathy Horvath is one such outspoken critic. Her 6-year-old disabled son Scotty died after Tennessee's Medicaid system declined to pay for special oxygen equipment. Horvath has told lawmakers there that Tennessee's cutbacks will likely hurt more children.