MySpace


MySpace.com | rss | sign in
Health Care For All – NOW – Take Action



Last Updated: 7/11/2009

Send Message
Instant Message
Email to a Friend
Subscribe

Blog Archive
[Older      Newer]
 /  / 
July 11, 2009 - Saturday 

Category: News and Politics

Insurance Industry Whistle Blower Reveals Insurance Lobby's Secret Plan to Attack 'Sicko' and Michael Moore

Wendell Potter, former Head of Corporate Communications at CIGNA (which provides health insurance to nearly 70 percent of the Fortune 100 companies) admits that, in fact, "Sicko" "hit the nail on the head" and told the real truth about how much better people in other countries have it when it comes to their health care.

The Bill Moyers interview contains a stunning revelation and admission by a top health insurance executive -- that the disinformation and attacks on Michael and the film were extensive and well-planned. Their job was to stop the movie from reaching a wide audience (and, more importantly, from having the widespread political impact the industry feared "Sicko" would have).

Potters discusses his take on the campaign to smear Michael Moore, his experiences inside the health insurance industry, their work fighting the public option and the insurance companies close ties to Washington.  

Click here for direct link to the entire interview at http://www.pbs.org/moyers. 


6:18 AM 
0 Comments
(Add Comment) |
Translate
July 11, 2009 - Saturday 

Category: News and Politics

Public Citizen has called on the public to: 
 
"tell Congress loud and clear that lawmakers must order the Congressional Budget Office to compare the cost of a single-payer system with the cost of other health reform proposals."

Because, as we all agree:  "We know this will show that the single-payer solution is the way to go."

Please go to this link and take action.

http://action.citizen.org/t/6693/campaign.jsp?campaign_KEY=2
7576

Also, http://1payer.net/faxapp/senders/add/cid:6


THANK YOU!

1:30 AM 
0 Comments
(Add Comment) |
Translate
June 30, 2009 - Tuesday 

Category: News and Politics

Response to PjNoel's World's
"NEWSFLASH! SINGLE PAYER HEALTHCARE = MORE DEATHS (by the numbers?" 
Every now and then, we get comments or links to blog posts like the one above. 

This time Dr. Joel A. Harrison decided to respond.  Enjoy.


How to Lie with Statistics

Joel A. Harrison, PhD, MPH

 

According to PjNoel's World: “DENMARK, SWEDEN, and CANADA are the countries that have single payer health care system. UK, FRANCE, RUSSIA, GERMANY, JAPAN, and CHINA have some form of SOCIALIZED health care system.”

 

The definition of a single-payer system is one in which the government finances health care; but care is delivered in the private sector, that is privately run hospitals and clinics and privately practicing physicians. In a socialized health care system the government both finances and delivers care, that is the hospitals and clinics are owned by the government and physicians are salaried by them. PjNoel's World got it wrong on several of the countries. Denmark and Sweden have socialized health care systems. While both have some doctors in private practice, hospitals are run by county governments and most physicians are salaried. The UK also has socialized medicine where hospitals are mostly owned by the state and specialists are salaried. Primary care doctors are in private practice. Canada is the purest form of single-payer where almost all hospitals are privately owned and most doctors in private or group practice. France is neither. France has 3 large and 14 small non-profit health funds (membership is determined by ones profession) which by law everyone must belong to one of these. Funds come from a payroll tax and, for those who are unemployed, the state pays the funds. Delivery is by privately practicing doctors and a mixture of private for-profit hospitals, private non-profit hospitals, and publicly-run hospitals. The publicly-run hospitals are responsible for the most serious types of illness and injuries, including burn units, and are the teaching hospitals for the medical schools. Germany has mainly private practicing physicians and a mixture of public and private hospitals with several non-profit funds which one is free to choose, paid for from a payroll tax. So France and Germany are more like single-payer in that universal financing is from publicly mandated non-profit funds and most care is delivered in the private sector. So PJNOEL'S WORLD GOT IT WRONG. APPARENTLY HE DOESN’T UNDERSTAND THE DIFFERENCE BETWEEN SINGLE-PAYER AND SOCIALIZED MEDICINE. To read about the various health care systems go to European Observatory on Health Systems and Politics, a branch of the WHO. The observatory prepares monographs of the health care systems of countries based on a template so that they are comparable. They are free for downloading. The complete monographs are about 150 pages (called Health Systems in Transition); and one can also download 8 – 10 page summaries (called HiT Summary). Go to http://www.euro.who.int/observatory. On the right click on “Health System Profiles.” Then either click on “HiT country profiles” or “At-a-glance HiT summaries.”

 

PjNoel's World then presents UNADJUSTED MORTALITY RATES BY COUNTRY as he states, “I present the data in manner of MOST NUMBER OF DEATHS at the TOP and by the thousands (multiply the numbers by 1000).” Concluding with: “Why do UK, France, Canada, Denmark, Sweden and Germany have more cancer deaths than USA? THE NUMBERS DO NOT LIE. SINGLE PAYER = MORE DEATH.” Unfortunately, the NUMBERS DO LIE.  PjNoel's World apparently does not understand statistics, especially as used by epidemiologists. An example from a well-known epidemiology text compares the 1962 mortality rates in Sweden with Panama. “Sweden, with a population of 7,496,000, had 73,555 deaths for a mortality rate of 0.0098/year, whereas Panama, with a population of 1,075,000, had 7,871 deaths for a mortality rate of 0.0073/year. Apparently the mortality rate in Sweden was a third greater than that in Panama. Before concluding that life in Sweden in 1962 was considerably more risky than life in Panama, we should examine the mortality rates according to age. For our purposes, the following age-specific mortality data suffice.” (Kenneth Rothman, “Modern Epidemiology,” Little, Brown and Company, 1986, page 41.)What PjNoel's World failed to do is what is called in epidemiology “standardization.” One adjusts all groups to one standardized age-distribution (ibid). So let’s look at the age distributions of the various countries (to simplify I just give median age and percentage of population over 65. (taken from CIA World Fact Book, 2007, available on line at https://www.cia.gov/library/publications/the-world-factbook/). For those who might be inclined to believe that the percentage of immigrants is related to health, I also give these (OECD, “Counting Immigrants and Expatriates in OECD Countries: A New Perspective” 12 March 1005 - http://www.oecd.org/dataoecd/27/5/33868740.pdf):


 Country         Median Age   Percentage > 65         Percentage Foreign Born
Canada           39.1                 13.5                             19.3

Denmark         40.1                 15.4                             6.8

France             39                    16.2                             10.0

Germany         43                    16.2                             12.5

Japan               43.5                 21.0                             1.0

Sweden           41.1                 17.9                             12.0

UK                  39.6                 15.8                             8.3
United States    39.1                 12.6                             12.3


Note that Germany has slightly more foreign born that the U.S. and Canada a much higher percentage.


Other factors all contribute to health, e.g. smoking rates are much higher in France than in the U.S. Campaigns to lower smoking rates and recent laws restricting smoking have been implemented in France. However, as is obvious from the table above, the U.S. has the smallest percentage of older citizens and the lowest median age. If an older person gets cancer, then their survival chances are lower. That should be obvious. What else should be obvious is that people die younger in the U.S!


I do not intend to waste my time doing the adjustments diagnosis by diagnosis. However, according to a recent study “One measure of the health of Americans—deaths from treatable conditions—still does not compare well with rates in other industrialized countries. . . Applying the corresponding death rates to the U.S. population, we estimated that between just under 75,000 deaths (average of eighteen OECD countries) and just over 101,000 deaths under age seventy-five could be saved in the United States.”  (Ellen Nolte et al “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, Vol. 27. No. 1, January/February 2008, http://content.healthaffairs.org/cgi/content/abstract/27/1/58?ijkey=05uD...).

For more on various process and outcomes measures see Joel A. Harrison's Response to “DON’T FIX WHAT ISN’T BROKEN,” East County Magazine, June 21, 2009, http://www.eastcountymagazine.org/?q=node/1429. See also Joel A. Harrison’s “Paying More, Getting Less,” Dollars and Sense Magazine, May/June 2008. http://www.dollarsandsense.org/archives/2008/0508harrison.html



 
6:05 PM 
8 Comments
(Add Comment) |
Translate
June 25, 2009 - Thursday 

Category: News and Politics
June 23, 2009 – 9:52 p.m.

Spouses in Health Care Affect Members’ Views

By Edward Epstein, CQ Staff


Nearly four dozen members of Congress have spouses employed in the health care industry — ties that lawmakers acknowledge are influencing their thinking about how the health system should be overhauled.

Financial disclosure forms made public in mid-June showed that at least 39 members were tied to the industry by their spouses in 2008. In addition, 13 full-voting House members are medical doctors.

Six senators reported that their spouses earned income from health industry jobs. An additional two, Republicans Tom Coburn of Oklahoma and John Barrasso of Wyoming, are physicians.

The influence and connections that result from this little-examined reality of Washington life rarely violate ethics rules or laws. But the experiences can make a significant difference in how members view health care overhaul proposals.

Rep. Shelley Berkley , D-Nev., for example, wants qualified Medicare recipients to get coverage for bone density tests.

Six weeks into their courtship a decade ago, Berkley’s husband, Larry Lehrner, a Las Vegas kidney specialist, tested a bone density imaging machine he had just purchased for his office on Berkley.

“‘We just got a new machine. Let me try it out on you,’ ” she recalled him saying.

The machine helps identify women prone to developing osteoporosis, which makes bones fragile and more susceptible to fractures. Berkley’s test showed she was developing osteoporosis and required her to go on medication that she continues to take today.

“It’s a $200 test, but Medicare has cut payments for bone density tests by 60 percent,” Berkley said. She called that short-sighted because it means thousands of older women will suffer broken bones and other osteoporosis-related injuries because they lacked information to seek treatment, she said.

A Ways and Means Committee member, Berkley introduced legislation (HR 1894) in April to restore Medicare funding for the tests, just one of the many proposals lawmakers have pushed for inclusion in the health care package.

Berkley has rounded up 98 cosponsors and frequently lobbied senior Ways and Means Democrats in advance of the release June 19 of a draft health care overhaul bill. The draft includes Berkley’s call that Medicare eliminate a co-payment for the test.

“As a doctor’s spouse, I’ve learned a lot about the practice of medicine and the problems that doctors and their patients face,” she said.

Lehrner said he and Berkley talk a lot about how to overhaul health care. “She has a much greater grasp of health care than 90 percent of the people in Congress. And that comes through me,” he said.


3:46 AM 
2 Comments
(Add Comment) |
Translate
June 25, 2009 - Thursday 

Category: News and Politics
Public health plan could save money faster: policy group
 
Reuters Susan Heavey Susan Heavey - Wed Jun 24, 8:00 am ET
 
WASHINGTON (Reuters) - A nationwide health insurance exchange that includes a Medicare-like government option could save $1.8 trillion more than if only private plans are offered, a prominent private U.S. health policy group said on Wednesday.
 
Federal spending on health-related costs would still rise from 2010 to 2020, but they would be less with a plan that pays doctors and hospital rates similar to the Medicare program for the elderly and disabled, according to a report by the Commonwealth Fund.
 
 
Source
http://...com/nb3p62
3:33 AM 
10 Comments
(Add Comment) |
Translate
June 21, 2009 - Sunday 

Category: News and Politics
For those who wish to help us spread the word, please just post links to our blog posts instead of copy pasting our blogs.  Posting just the links so people read the article on our blog helps keep us in the top blogs so even more will find us.  Dr. Harrison has written articles exclusively for our page so those reading can have access to all the information on this page and future articles. Thank you!

The View from the Riverbank
By Joel A. Harrison, PhD, MPH
(first draft June 21, 2009)
 
Imagine standing on the bank of a river and suddenly seeing someone, perhaps a child, helplessly floating by. You jump in to rescue them; but while bringing the one you have saved to shore several more float on by. Over and over again you jump in, rescuing one while others pass on by. Well, heh, you’ve done yours. You’ve shown you are a caring responsible person. Too bad more people don’t jump in to save the others; that is if others just happen to be passing by at the right time. In any case, you’ve done yours and now you’re tired and heading home.
 
Someone may take the time to ask why so many people are floating by, obviously drowning. An investigation is conducted and the following facts are determined:
 
1.  All residential housing is on one side of the river.
2.  All schools, shopping centers, grocery stores, and factories are on the other side.
3.  There are two bridges spanning the river.
            a. One is a beautiful work of architecture with covered walkways and even an overhang complete with picnic tables and umbrellas.
            b. The other is a makeshift flimsy construction, totally unsafe to use in inclement weather, and, except in totally calm weather, risky to cross at most times.
4.  The first bridge is privately owned and charges a toll.
5.  The second bridge was built by volunteers, perhaps with some public funds.
6.  30 – 40% of the population can’t afford the tolls; however, some charities do provide passes for some of the children, enabling them to attend school. 
7.  Approximately 65% of the first bridge was subsidized by public grants and tax rebates to the companies that built it.
8.  Because of weather the second bridge is often unsafe:
            a. Thus children miss school, are less prepared to become contributing productive members of society and some end up in prison.
            b.  Workers miss days of work, reducing productivity of the companies they work for and, of course, their own standard of living.
9.  Since the tax payer already paid for most of the 1st bridge’s construction, a simple analysis shows that reimbursing the difference in construction costs to the private company, making it public, will grow the economy far beyond the cost of taking it over, e.g. better educated and productive students, more productive work force, lower criminal justice costs.
 
I know many libertarians who would not hesitate to risk their lives to jump in and rescue someone in distress; they are neither cruel nor insensitive. However, they fail to see the big picture. They are locked into a vision of society based on 18th liberalism which they rigidly adhere to. They fail to appreciate the public goods, the infrastructure that has enabled them to achieve whatever quality of life they have. They believe they have earned it completely on their own; but can’t explain why their standard of living is so much higher than much of the world. Yet, had they been born in a Third World Nation, regardless of how enterprising they might be, regardless of the efforts of their families, lack of clean water and safe food, good schools, libraries, a safe environment to grow up in which we should give thanks to our police, fire departments, and public health, good roads for the transportation of goods and movements of people, the research findings funded by tax dollars, and a military that keeps us safe, all the things we often take for granted, all the public goods and infrastructure that allow us to thrive, would not be there.
 
Part of the public goods that we benefit from are our state-of-the-art hospitals, many either built or renovated by government funding, starting with the Hill-Burton Act of 1946. Much of the high tech equipment found in our hospitals was mostly paid for by Medicare and other government programs. Almost all specialty residencies have been paid for by Medicare. Most, probably more than 95%, basic research in the sciences and in medicine is carried out either at our universities and medical schools, funded by government grants, or, for medicine, conducted by our National Institutes of Health. Over 50% of breakthrough drugs are developed at the NIH or on government grants, and, of course, our Centers for Disease Prevention and Control. No state or community could possibly afford the expertise, labs, and other resources that keep us safe from infectious diseases. Unless one chooses to live as a hermit far away in the mountains, no individual could possibly protect themselves in the event of a pandemic. Our entire health care system receives more than 65% of its funding from the taxpayer. I have looked through numerous economic textbooks and have not been able to find a single example of a free market that is subsidized by taxes to such an extent. Health care does not function as a competitive market consumer good. I’ll come back to this in a moment.
 
My little bridge narrative was an attempt to show how the libertarian way of thinking is counterproductive. First, it ignores the blessings received from public goods; but second, it fails to understand the role that public goods and infrastructure play in creating our dynamic economy. Without them, except for the few elites that thrive even in Third World countries, our standard of living would suffer. Allow me to give a real example.
 
A number of years ago, Pete Wilson, the Republican governor of California, was instrumental in getting a Bill passed which lowered car license taxes. At the time the State had a surplus which it shared with the Counties and Cities. The Bill stated quite clearly that if the surplus were to dry up, the license fees would automatically return to their previous level. Well, the surplus dried up and the license fees were raised. People were outraged; after all, California was where the tax revolt that has spread to every corner of our nation began. Governor Gray Davis, a Democrat, not exactly the most charismatic of governors, was blamed for the increase (no one cared that it was automatic from a bill passed by a Republican governor). Arnold Schwarzenegger campaigned promising to lower the car license tax to its “original” level, something he did immediately upon being elected. I received a refund of $84. At the same time, my hometown lost the funding and began cutting services. Library hours were cut, potholes not repaired, schools not repaired, school supplies cut, recreation center hours were cut (so instead of expending energy in a supervised environment our kids were left to fend for themselves. For those who believe their parents bear responsibility, if parents stay home who will put food on the table?), police and fire department funding was cut, etc.
 
I remember not too long ago devastating fires where TV news interviewed someone standing outside their burning home complaining there wasn’t a firetruck in sight. I wonder had they known of the impending fires if they might have been willing to pay a bit more in taxes.
 
In any case, my $84 was the equivalent of $7 per month. We are told by the right-wing ads that we know better how to use our money than the government does. So what could I possibly do with my $7 per month compared to we, as a community, all putting our respective $7 into funding police and fire departments, libraries, recreation centers, schools, public health, street repairs, and a host of other government services. Public goods are what we as a community build together, either because they could not be built at all by individuals or because they are much more cost-effective and fair. Could we really have for-profit fire departments? What happens when our neighbors don’t want to pay? If we paid, would a fire truck standby while our neighbors home burned to the ground, hoping they could stop the blaze from destroying our home, or would they nip the fire in the bud, stop it from spreading, even if it meant saving a home that had not paid them?
 
The problem with opponents of single-payer, a government funded; but private sector delivered health care system, is they don’t understand public goods. They don’t understand that market models simply don’t apply to health care. Not only can it not be a free-market when the taxpayer pays for over 65% of it; but it can’t work as a free market because none of the principles/assumptions underlying a free-market model apply.
 
In Nobel Prize winning economist Kenneth Arrow’s article and Professor Thomas Rice’s book, they go through the classic assumptions of a free-market model showing how they do not and cannot apply to health care. See Kenneth Arrow, “Uncertainty and the Welfare Economics of Medical Care,” The American Economic Review, Vol 53, No. 5, December 1963. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf and Thomas Rice. “The Economics of Health Reconsidered.”
 
F.A. Hayek, considered the founder of free market libertarian economics, wrote in his seminal work, “The Road to Serfdom,” “Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance—where, in short, we deal with genuinely insurable risks—the case for the state’s helping to organize a comprehensive system of social insurance is very strong.” F. A. Hayek. “The Road to Serfdom (Fiftieth Anniversary Edition), Chapter 9: Security and Freedom, page 133. The University of Chicago Press, 1994.
 
Our current fragmented dysfunctional health insurance industry cost us approximately 25 cents of every dollar going into health care. In return, they exclude those with pre-existing conditions, often limit our choices of doctors and hospitals, exponentially increase our premiums after an illness or injury, especially if we have individual polices, delay and deny care, and possible bankruptcy (60% of bankruptcies in U.S. do to medical costs and over 75% are those with health insurance). They neither improve the timeliness or the quality of the care we receive despite their protestations to the contrary. They simply function as an unnecessary middleman taking their share, a rather big share of the pie. CEOs for the private health insurance industry have often retired multimillionaires, some in the 100s of millions. Is it surprising that they would do their darndest to stay in business? So why do we succumb to their 30 second sound bites, to papers written by industry-funded right-wing think tanks? Rather than blindly parrot their red flag slogans, e.g. “choice” (they mean choice of insurance company, single-payer means you choose the doctors and hospitals), “government-run” or “socialized medicine” (single-payer is government financed; but care will be delivered in the private sector); “rationing” (we already have rationing, over 22,000 die each year, others suffer delays and denials, with single-payer the 25 cents on the dollar wasted will go to health care, more than enough to cover everyone with timely quality care), etc.
 
It might interest some to know that our for-profit health insurance companies, according to a recent report, have invested heavily in the tobacco industry. (see “Life, health insurers invest big in tobacco,” June 4, 2009, Yahoo News at http://news.yahoo.com/s/afp/20090604/wl_canada_afp/ushealthcancertobaccocanadabritain_20090604131549). Gee, I guess they really go the extra mile to show how much they care about our health or, oops, about their bottom line.
 
I started with a narrative about someone standing on a river bank. This person may be a libertarian, someone afraid of government, someone who misunderstands the role of government in creating the public goods and infrastructure which form the bases of our dynamic economy. They are so locked in a rigid ideology that everything they read and hear is filtered. Slogans, red flag words, empty phrases, all that ring true, are accepted without reflection. They may, on a personal level, be quite compassionate, caring people, even willing to risk their lives for others; but they just don’t understand that we do not live in an 18th Century world with yeoman farmers. We live in a complex, often urban, world where only by creating a commons can we all thrive.
 
We already pay over 65% of health care in the U.S. through our taxes, including the taxes of many who do not have insurance and either can’t afford it or have pre-existing conditions making them non-insurable; but still able to work and pay taxes. Another 15% of health care is paid by us out-of-pocket. The remaining 20% is simply monies paid into the system that do not give us health care; but pay an industry that at best plays middleman; but more often makes the care we have already paid for more difficult to obtain. Despite propaganda from the industry trying to maintain their riches and their right-wing allies, many other countries with non-profit universal health care do much better than we do on such measures as infant mortality, life-expectancy, survival on treatable medical conditions, and even timeliness (e.g. virtually no wait times in France and Germany, and Canada does much better than the propaganda would have us believe and is currently investing huge sums to both improve the quality and timeliness of care.) And they do this for much less money, leaving more money to invest in infrastructure, schools, research and development, which in turn improves the quality of their lives. In fact, the 80% we currently pay into health care through taxes and out-of-pocket is more than any other nation pays for total care. In other words, with single-payer we will have more by far money going into health care than any other nation. Finally, for those who worry about the quality and timeliness of health care, I suggest you download for free the pdf version of Dr. Michael Rachlis’ book “Prescription for Excellence,” at www.michaelrachlis.com. He gives numerous examples from around the world of improvement in quality and timeliness and shows how such improvements were far easier to carry out in a single-payer system. Then go to Physicians for a National Health Program’s website at www.pnhp.org and read at your leisure. You will find papers on health care in foreign countries, comparative studies of health care outcomes, and a “Frequently Asked Questions” section.
 
 
 
5:13 PM 
9 Comments
(Add Comment) |
Translate
June 17, 2009 - Wednesday 

Category: News and Politics


Congress to Transfer Hundreds of Billions in Tax Dollars to the Insurance Industry

Tuesday 16 June 2009
by: Kevin Zeese, t r u t h o u t | Perspective
Single-payer witnesses show the common-sense path, but Congress is listening to industry donors.
 
Yesterday, as Sen. Tom Harkin (D-Iowa) left the health-care hearing room, he leaned over to me and said:
"I used to sell insurance. The basic rule is the larger the pool the less expensive the health care. Today we have 1,300 separate pools - separate health care plans - and that is why health care is so expensive; 700 pools would be more efficient and less expensive and one pool would be the least expensive. That's why single payer is the answer."
Nothing like common sense.
But, common sense was not on display in the Senate yesterday. Instead, the Senate is seeking a path to the goal of universal coverage by protecting the least-efficient model - the for-profit insurance industry that through waste, fraud, abuse and bureaucracy eats up 31 percent of the cost of health care.
Chris Dodd (D-Connecticut) who chaired the hearing, standing in for the ailing Ted Kennedy, has received $2.1 million from the insurance industry throughout his career, another $547,000 from the pharmaceutical industry and $467,000 from health care professionals. Dodd opened the hearing stating the stark facts:
Americans spend more than $2 trillion on health care every year - more than 18 percent of our GDP. By 2040, 34 cents of every dollar we spend could be on health care. That is not simply unacceptable - it's unsustainable. Premiums and out-of-pocket costs for individuals and families alike continue to skyrocket.
It was evident throughout the day that money was on the minds of the senators. But, they could not look into the face of the obviously most efficient path, single payer. Instead, they were going through contortions to protect their benefactors in the insurance industry.
The senators and witnesses showed there is a lot of division over financing health care and no easy solution - so long as the first goal is to protect the insurance industry. Business groups wanted to tax employee benefits, not take away the business tax credit for companies that provide health care. These are the only two big pots of money the Senate sees. There was also talk about making Americans healthier to save money, certainly a good goal. But, Sen. John McCain (R-Arizona), probably correctly if rudely, mocked witnesses who said health care could be paid for by doing away with inefficiencies and wellness programs. McCain favors taxing health care benefits.
Of course, both the business tax credit and not taxing health benefits are two reasons the health insurance industry is able to acquire massive wealth. These are annual, indirect taxpayer giveaways to the insurance industry that demonstrate how government is already paying for health care. Taxpayers are just doing so in the most inefficient way. Rather than actually using tax dollars to pay for health care, they are used to pay for insurance and all the profits and waste that goes with it.
Sen. Bernie Sanders (I-Vermont), the sponsor of S.703, the single-payer bill in the Senate, finally got his chance to speak and railed against the waste of the health insurance model, criticized their massive profits and emphasized that health care was a human right. He pointed his question to the lone witness advocating for single payer of the dozen testifying, Dr. Margaret Flowers of Physicians for a National Health Program.
Flowers, who had been arrested just six weeks ago for protesting the exclusion of single payer from discussions in the Senate Finance Committee, went into a long list of reasons why the multi-payer system is so expensive - inefficiencies built into the system, insurance companies making massive profits while people died from lack of health care access, hospitals needing massive billing departments creating bigger administrative staff than nursing staff, doctors spending 20 percent of their overhead on dealing with the insurance industry, fee-for-service payments that lead to unecessary treatments and expensive, often-unneeded tests, malpractice litigation because patients do not have access to health care, to bad health care outcomes ...
Flowers was still going strong and the list was incomplete, when Sanders cut her off, saying he only had a few minutes for questioning.
Sitting next to Flowers was the CEO of Aetna Insurance, Ronald Williams. The senators fawned over him - except for Sanders, who pointed out Medicare was more popular than Aetna. Williams makes anywhere from $13 million annually in salary and stock (according to Insurance Industry News) to $30.86 million annually (according to Forbes). Insurance Industry News reports that if Aetna grows by 15 percent by 2010, Williams gets an additional $4.3 million. Is he not the perfect example of what is wrong with health care in America? Profits are the top priority of corporate interests, and usually short-term profits. Should the insurance industry be striving to grow so rapidly when it already gobbles up too many health care dollars?
The Senate also struggled with how to make sure everyone is covered with health insurance. Again, the divisions were obvious. Business groups said there should not be an employer mandate, but rather an individual mandate. Unions said there should be an employer mandate, not an individual mandate. Big businesses said there should be no subsidy for small businesses that would be unfair to big businesses. Republicans scoffed at the idea of expanding Medicaid to more of the working poor - too expensive and unaffordable, they pointed out. The public insurance option was described as unfair to the insurance industry and too expensive to implement. The Democrats squirmed uncomfortably at choices that they know will upset some powerful interest group.
What a mess! The effort to protect the insurance industry at all costs is making real health care reform impossible. Maybe, because the Democrats want to do something, anything, so badly they will find a way to pass something, but if they do it will not work, it will be very costly and the group that will benefit most clearly will be the health insurance industry - which will reap hundreds of billions in corporate welfare every year from the deform of health care in America. Of course, incumbents who support it will benefit with campaign donations from the industry. Pay to play politics on display in America.
Margaret Flowers, MD, was the first witness to testify at the Senate hearing on June 12. Her comments focused on health care as a human right. She pointed out how FDR was the first to try to put in place a Social Security system that included a single-payer health care system. And, how years of trying the "uniquely American approach" of the market solution - for-profit health care - had failed the country and put health care on a path to government deficit with health care costs already a cause in two-thirds of bankruptcies. She urged the Senate not to tinker with a broken system, but instead to take a new path and adopt a national health plan with single payer as the financing system.
Sadly, there were four doctors on the panel and only one, Flowers, who spoke of health care as a human right. Perhaps the AMA was the most despicable. Not only did it oppose single payer - something supported by 60 percent of doctors, according to a survey of the AMA data base - but it even opposed the weak public insurance option. The AMA spokesperson said they would only support market approaches. No wonder the AMA is shrinking rapidly. While not long ago it represented 70 percent of American doctors; it is now down to only 30 percent. At this hearing, the AMA's callous disregard of the needs of patients and its disregard of the opinions of doctors showed why the AMA is a shell of an organization.
Senator Sanders pointed out the historic breakthrough of having the first witness for single payer being allowed to testify as part of the health care reform discussion. The audience began to applaud and Sanders warned, "Be careful, you might get arrested."
The day before this hearing, a House subcommittee held a session on single-payer health care. One witness, Dr. Walter Tsou, a University of Pennsylvania professor, former health commissioner and an adviser to Physicians for a National Health Program responded to the claim that single payer was too radical, saying, "Our most famous radical document begins with the words, 'We the People.' Not 'We the Insurers,'" he said. "It is time for our own generation's revolution."
And, it will take the people speaking out and getting active to make real health care reform possible. If you don't want to see another massive transfer of wealth to the insurance industry while Americans continue to lack health care, you need to take action. Tell your representatives that you want a national health plan funded by a single-payer system. The insurers are working hard; the American people have to work harder. The time is now.

******
Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.  http://www4.law.cornell.

5:21 AM 
3 Comments
(Add Comment) |
Translate
June 17, 2009 - Wednesday 

Category: News and Politics
THE TRUTH ABOUT HEALTHCARE REFORM: WHAT YOU DON’T KNOW CAN KILL YOU

"Single-payer is the health system that works for every other industrialized nation on earth."

By Sylvia Hampton  Sylvia-headshot-April-06-sm.jpg

Supporters of real health care reform want a national expansion of the popular Medicare single payer program now covering every American over age 65. But they are being told that it is just not “politically feasible.” When one asks “Why?” there is double talk and a run-around. The facts are clear. Oxen will be gored--and the industry and some in Congress are circling the wagons to protect their own self interests. We have some blatant conflicts of interest here that would make an eight-year-old blush: Congress members who have stock holdings in the industry and get large campaign contributions from insurers. Imagine that.

The insurance industry competes by selling large group insurance to businesses employing young healthy people. Ca-ching! They get those contracts by promising low cost to the employer, so the employee “contribution” becomes a pay deduction. Then if an employee gets sick or in an accident, his co-pays can become so large as to cause him to go bankrupt. But hey---no skin off the insurance company’s nose! Ca-ching.

If the sickness or injury is bad enough to lose your job they don’t have to mess with you anymore. They just drop you if you live long enough (after they do everything in their power to deny the claims.) After all, they have stockholders to think about---they must, by law, make a profit. Ca-ching. And because the drug companies don’t want to have to negotiate with the big bad government on prices, they stick with the captains of this industry like two peas in a private money pot. That’s what makes health insurance hooked to employment so darn great--for insurers. The result is that they have so much money they can scare the pants off everyone in government. They will run an ad campaign so slick a good guy will look like Satan when they are done.

Who gets the money for all those campaigns to sell insurance, sell drugs, sell the negative campaign ads? The Media. Ca-ching. So don’t ask them to help you gore that ox. That money talks---big time.

Single-payer is the health system that works for every other industrialized nation on Earth. Single-payer results in health statistics better than ours, costs the people far less than ours, and at the same time covers everyone in their country. But it was not given consideration in Congress and is deemed an evil communist plot by 30% of our population. The other 70% have caught on after hard knocks in our system and now support single payer/Medicare for all. But that is not even what the president is asking for; he just wants a “public option” in addition to the private plans.

But no, the industry says that is not fair. Why? Too many employers and workers will grab it in a heartbeat. Why? Better, cheaper, faster, nicer and more complete---like what all of us over 65 have and love: Medicare. The modern robber barons are throwing so much money and weight around Washington D.C. right now that you ordinary people out here in the real world don’t have a chance.

There is only one way you young ‘uns will get what I have--and that is to take to the streets and demand it. Call your congressman, demonstrate in the street by his office, call the talk shows, and scream bloody murder. Because murder is what is happening to you right now. They are killing you. But as long as insurers, drug companies and legislators make a profit and you don’t pay attention, their life goes on.

Sylvia Hampton is the past director of Health Care for All CA and a current board member of San Diegans for Health Care Coverage.


******
Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.  http://www4.law.cornell.



5:12 AM 
1 Comments
(Add Comment) |
Translate
June 7, 2009 - Sunday 

Category: News and Politics

Exaggerated Problems with Health Care in England:

Misleading Anecdotes

by Joel A. Harrison

Those who oppose single-payer health care pick and choose their anecdotes, their horror stories. England has had some problems with waiting lists; but France and Germany, two other non-profit universal health care systems, have basically no waiting lists. In France, one can get to see a specialist often within one to two days, and, on average, the doctors spend more time per visit with patients than in the U.S. Canada has had some problems with waiting lists; but they have been grossly exaggerated. Canada has been investing huge sums to both improve quality and timeliness of health care. I intend to write a separate piece about this later. However, in some areas of Canada, waits are shorter than in the U.S. (see Claudia Sanmartin et al. "Waiting for medical services in Canada: lots of heat, but little light." CMAJ, May 2, 2000, Vol. 162, No.9, pp 1305 - 1310.
http://www.cmaj.ca/cgi/reprint/162/9/1305; Michael M. Rachlis. "Public solutions to health care wait lists." Canadian Centre for Policy Alternatives, December 2005. http://www.policyalternatives.ca/documents/National_Office_Pubs/2005/Health_Care_Waitlists.pdf; "Rekindling Reform: Health Care Renewal in Canada, 2003 - 2008," June 2008 http://www.healthcouncilcanada.ca/docs/rpts/2008/HCC%205YRPLAN%20(WEB)_FA.pdf; "Wait Time Alliance April 2007 Report Card" http://www.waittimealliance.ca/images/report_card.pdf)

It is also important to ask the question: "Compared to what? According to the Institute of Medicine at least 22,000 Americans die each year from lack of health care because they don't have insurance. Even more suffer decreased quality of life and disability due to being uninsured and, thus, delaying seeking care. And for every anecdote about someone supposedly dying while waiting for care, here in the U.S. we have a myriad of such stories. I suggest starting with Donald Barlett and James Steeles' recent book, "Critical Condition: How Health Care in America Became Big Business and Bad Medicine." They give numerous accounts of delays and denials for people with insurance.

I just want to focus on England briefly. When Margaret Thatcher was Prime Minister, as a free-market conservative, she wanted to privatize health care in England. However, as the British National Health Service was very popular she couldn't just abolish it; but instead she attempted to undermine it by cutting funding significantly, e.g. to "starve the beast." The result was ever longer waiting lists, deteriorating infrastructure (lack of facility maintenance), and health care personnel fleeing from the public health sector. At one time, under Thatcher, Britain spent only 6% of her GDP on health care. At the time, the U.S. spent 12% or more. Despite this, international comparative studies show life-expectancy, infant mortality, and survival on treatable medical conditions in England similar to the U.S. They actually have better access to primary care and family physicians get additional sums over standard office visits to spend time working with patients with chronic conditions such as diabetes.

The labor government came to power with the mandate from the public to save their National Health Service. Funds have been pumped into improving infrastructure, recruiting personnel, and improving quality and timeliness of care. Waiting lists have been cut substantially, in some areas basically disappearing. It, of course, depends on what one means by waiting lists. If I phone to see my family doctor it usually takes a week or two to get into see him. If he then refers me to a specialist, this may take a couple of weeks also. If I have an emergency I would go to the emergency room, otherwise, I accept some waiting time. Would I really want a doctor who had so much time on his hands that he could see me at a moments notice?

Currently, Britain spends more than 8% of her GDP on health care, a substantial increase from the Thatcher years. In the U.S. we are rapidly approaching devoting 17% of our GDP to health care. However, our fragmented dysfunctional for-profit system uses up between 25% to 30% for wasted unnecessary counterproductive administration and profit. For more detail on how this works see my article "Paying More, Getting Less: How Much is the Sick U.S. Health Care System Costing You?" at http://www.dollarsandsense.org/archives/2008/0508harrison.html and my draft paper "The Supposed Difficulties of Converting to Single-Payer" at http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=144312962&blogID=491626677.

Subtract the amount going to wasted administration and profit and the actual percentage of our GDP going to health care is around 12%, still 50% higher than Britain's 8%. We are also a richer country, so the real amount spent on health care is higher. If we convert to single-payer, the 25% to 30% currently not going to actual health care will. So for those who are worried about waiting lists, substandard care, and believe that despite everything, care is currently better in the U.S. than England, imagine how it will be if we can increase the percentage of our GDP going to actual health care from 12% to 16+%. Or imagine how England's health care would look if they more than doubled the percentage of their GDP going to it.

We have some of the best health care facilities in the world. We have well-trained medical personnel and we actually have too many MRIs and other high tech apparatuses. Single-payer will not remove any of these, simply direct the funds now be wasted to actual health care. Anecdotes about other countries are simply that. No system is perfect and one can always find horror stories. Individual horror stories, though one would hope they would never happen, do not say anything about a system. If anything, adoption of single-payer will lead to a decrease in our own myriad of horror stories.

**********
For those who wish to help us spread the word, please just post links to our blog posts instead of copy pasting our blogs.  Posting just the links so people read the article on our blog helps keep us in the top blogs so even more will find us.  Dr. Harrison has written articles exclusively for our page so those reading can have access to all the information on this page and future articles. Thank you!



5:17 PM 
10 Comments
(Add Comment) |
Translate
June 7, 2009 - Sunday 

Category: News and Politics

Private insurance companies push for 'individual mandate'

As momentum gains for reforms, insurers hope to turn it to their advantage by supporting a proposal that everyone buy coverage. It would be a boost for the industry, which has seen enrollment decline.
By Lisa Girion

June 7, 2009

One in an occasional series on healthcare reform.

Some may find it hard to believe that the U.S. health insurance industry supports making major changes to the nation's healthcare system.

The industry, after all, scuttled President Clinton's healthcare overhaul bid with ads featuring "Harry and Louise" fretting about change.

But this time, it turns out, the health insurance industry has good reason to support at least some change: It needs it.

Private health insurance faces a bleak future if the proposal they champion most vigorously -- a requirement that everyone buy medical coverage -- is not adopted.

The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare -- and stop buying private insurance.

Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can't afford it, and enforced with fines.

Such a so-called individual mandate amounts to a huge booster shot for health insurers, which would serve up millions of new customers almost overnight.

"I think that's why we've seen the industry basically trying to play the administration's game," said Jane DuBose, an analyst with industry tracking firm HealthLeaders-InterStudy. "They really could be licking their chops over the potential here."

The industry says its interest in change flows not from narrow self-interest but from broader concerns.

"What's driving this is we have 47 million people who don't have access to the system, who get help through emergency rooms, and that results in higher costs and inefficient care," said Robert Zirkelbach, a spokesman for industry trade group America's Health Insurance Plans. "There's both a social and economic reason to get everybody in the healthcare system."

Jay Gellert, chief executive of Woodland Hills-based Health Net, said industry support for certain changes is driven by "a recognition that public frustration with many of the problems in the system [is] increasing pretty significantly. So I think there's as much of a commitment to this because we've seen other industries where they haven't dealt with issues early enough, like financial services and auto, and that's not a happy place."

Still, industry observers say, private insurers need the government's help to transform some of the nation's 45 million uninsured residents into paying customers.

Private insurers lost an estimated 9 million customers between 2000 and 2007. In many cases, people lost coverage because they or their employers could no longer afford it as premium increases outpaced wage growth and inflation.

Recession job losses are adding to the toll. Some economists estimate that every percentage-point increase in the jobless rate adds 1 million people to the ranks of the uninsured.

The industry's real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors.

"The rate of aging far and away exceeds the birth rate," said Sheryl Skolnick, a CRT Capital Group healthcare investment analyst. "That's got to be very scary. . . . This is the biggest fight for survival managed care has ever faced, at least since they went bankrupt in the late '80s."

With Democrats in power and public sentiment in favor of change, the industry can't afford to flatly oppose it, said Julius Hobson, a Washington lobbyist for hospitals and insurers with the law firm Bryan Cave.

"This time, you get the sense something is going to happen," he said. "So to stand up and just say no is probably not wise, because politically you could get run over."

For insurers, getting "run over" would be the adoption of a so-called single-payer plan, in which the government pays all medical bills. Such a plan, though widely viewed as politically unfeasible this year, would wreak havoc on the private insurance market.

The best way for the industry to preserve the private insurance market -- and derail the campaign for a single-payer system -- may be to go along with more palatable proposals on the table now, said Jeffrey Miles, a healthcare analyst and president of the Miles Organization, a Los Angeles insurance brokerage firm.

"If healthcare goes down this year, you are going to end up with single-payer care much sooner than anyone expected," he said.

But there is a limit to how much change the industry will abide. It draws the line at proposals, supported by President Obama and others, to offer consumers a public insurance alternative to private coverage.

The idea is that consumers could buy into a government-run health plan, such as or similar to Medicare or the federal employees insurance program.

Proponents say that if consumers are required to buy coverage, it is only fair to give them a public option.

In a recent letter to Senate Finance Committee Chairman Max Baucus (D-Mont.), for example, Jerry Flanagan of the Santa Monica-based advocacy group Consumer Watchdog wrote that adopting an individual mandate without a public alternative would amount to "a bailout for HMOs -- whose greed, waste and indifference to our health have created the current mess."

The industry fears that the government would force lower fees on hospitals and physicians, enabling a public health insurance plan to offer consumers a better bargain.

That, they say, would make it hard for private companies to compete for customers. Insurers also fear that a public option could easily be converted later into a single-payer healthcare system.

Health insurers don't see a public plan "as the nose of the camel under the tent; they see it as the front half of the camel under the tent," said Robert Laszewski, a former insurance company executive and industry consultant.

"They are interested in 45 million new customers," he said, "but the first thing in everybody's mind is preserving their right to do business in a way that can be profitable and meet shareholder needs."

lisa.girion@latimes.com

******
Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.  http://www4.law.cornell.


5:11 PM 
4 Comments
(Add Comment) |
Translate
June 5, 2009 - Friday 

Category: News and Politics
Arthur Salm:
Let’s make the HMOs disappear
Arthur Salm is SDNN's city columnist.
Arthur Salm is SDNN's city columnist.

This is a column that shouldn’t have to be written, about a monstrous and horrific problem that needn’t be, abetted by an organization that shouldn’t exist.

Its annual convention is being held today and Friday in San Diego. That organization is America’s Health Insurance Plans.

The very name should be oxymoronic. People don’t need health insurance; people need health care. The only ones who need health insurance - that is, who need for health insurance to exist - are insurance companies and HMOs. It’s a gigantic, almost unimaginably lucrative business. CEOs and other top officers rake in millions, sometimes tens of millions in salary, benefits and stock options.

Meantime, 47 million Americans remain uninsured, and many of those who are insured find out how little their insurance is worth when a medical condition - caring for which is supposed to be what this is all about - threatens to prove expensive. People are afraid to leave their jobs, because they need the health insurance that comes with it; they stick with that company, they stay in that town, they put up with whatever they have to because if they don’t, they’re naked, exposed. And there’s not only the terrifying prospect of not getting treatment; a new Harvard University study links medical bills to 62 percent of the bankruptcies in this country.   

The key words are “in this country.” So many Americans do not know that these problems simply do not exist in any other western, industrialized democracy. People in Canada, for example, and Great Britain, France, Germany, Norway, Sweden, Denmark, Iceland, Finland, the Netherlands, Belgium, Spain and Italy do not agonize over hard economic choices such as: mortgage or health care; education or health care; food or health care. Everyone gets government-provided health care. Everyone. Everyone.

And we’re not talking leeches and pungent poultices administered by a drunken sawbones who arrives at your hut in the back of an ox cart; medicine as practiced in Europe and Canada is every bit as good, as effective, and yes, as advanced as American medicine. Generally, their infant mortality rates are lower than ours. And their citizens live longer. Big, floppy, foam-rubber hands featuring extended index fingers notwithstanding, we’re not #1.

Here’s how those other countries do it: They don’t, for the most part, even have health-insurance companies. (Those countries that do - the Netherlands is one example - still provide health care to all citizens through those companies.) Insurance companies siphon off about 30 cents of every dollar spent on health care in the U.S. Knock them out of the picture, and that 30 cents becomes about three cents : Medicare’s administrative overhead. The rest of the money? It’ll go toward providing good health care for 47 million Americans who don’t have it now. And toward providing good health care - the word “affordable” will be, in this context, DOA - for you and your family. Whether you’re employed or not. Whether the people you work for are tightwad jerks or not. Whether you move or not. Whether you’re married, or getting divorced, or single. It’ll be there. Always.

No, it won’t be free; it’ll be paid for by our tax dollars. But it’ll be no more expensive, and probably cheaper than what we’ve got now - a system that spends more on health care, per capita, than any of those countries that take care of all their citizens all the time.

That type of health care system is called Single Payer, because instead of a myriad of organizations insuring and (sometimes) paying (part of) a patient’s medical bills, the government pays the bills. And for the first time in generations, Single Payer is being taken seriously in Washington.

Being taken seriously, and seriously dismissed, that is: It’s officially off the table, as far as President Barack Obama is concerned. That may be more his recognition of political reality that it is his philosophy; at this time in this country, no matter how rickety and corrupt and infuriating our health-care apparatus may be, we seem not to be ready to join other civilized nations in this regard.

Still, Obama is driving hard for health-care reform to be enacted this year. One of the proposals that hasn’t yet been swept off the table by the insurance companies’ paid-for elected representatives is called the Public Option, which would allow people to stick with their current plan (if they have one) or sign onto a government-run, decidedly non-profit plan - sort of an Optional Single Payer. Insurance companies and HMOs would not be allowed to cherry-pick healthy customers: All plans would have to take on all comers.

(Step back for a moment, look at the big picture, and say these words out loud: “Pre-existing conditions.” Pre-existing conditions??!!! Of course some people have pre-existing conditions. That means they should be denied medical care? But isn’t medical care all about treating … Shouldn’t that be … How the hell did we ever allow such a cruel, barbaric concept even to enter the conversation?)

In desperation, opponents are suggesting a seven-year “trigger”: That is, if health care hasn’t been pretty much fixed in seven years, then the Public Option will be put into play. That’s actually a great idea, as long as we start the clock seven years ago, yesterday.

Mega-bucked and mega-threatened insurance and pharmaceutical companies, who have nightmare visions of losing their 24-carat cash cows; and right-wing, free-enterprise/libertarian dead-enders, who shriek “Socialism!” whenever a civilization moves to act like a civilization, have rolled out the artillery. The bombardment has already begun: People in “those” countries must wait months and months to see a doctor (a flat-out lie - and besides, how long do you wait to see a doctor?); medical decisions would be made by “government bureaucrats” (as opposed to insurance companies and HMOs, which go ka-CHING! every time they deny treatment or reject a claim); and - don’t forget! - “Socialism!” (Just like our socialist, government-run police forces; fire departments; public schools; universities; highways; air-traffic control system; ports; national, state, and local parks; public health departments; lifeguards; Social Security; Medicare; Army, Navy, Air Force, Marines, Coast Guard, and National Guard.)

But the old litany of distortion, misinformation and outright lies don’t quite have the traction they used to; the Big Money Boys are starting to slip in the very muck they spew out. A lot of people are on to them, and a lot of others, sick to death - sometimes literally - of the old ways, are listening to new (to us) ideas.

On Thursday morning, in front of the Convention Center, people showed up to protest this latest gathering of America’s Health Insurance Plans. Unlike the conventioneers, their concern is human beings, not profit margins. Michael Lightly was there. He’s director of public policy for the California Nurses Association. What’s in it for them?

“The only way to deal with the crises nurses see every day is to guarantee health care for everyone,” he said. “And the only way to do that is Single Payer.

“Money drives the system, instead of the health-care needs of the people.”

For now, anyway.

Arthur Salm is SDNN’s city columnist. Reach him at arthur.salm (at) sdnn.com.


******
Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.  http://www4.law.cornell.
10:35 PM 
5 Comments
(Add Comment) |
Translate
May 31, 2009 - Sunday 

Category: News and Politics

For those who wish to help us spread the word, please just post links to our blog posts instead of copy pasting our blogs.  Posting just the links so people read the article on our blog helps keep us in the top blogs so even more will find us.  Dr. Harrison has written articles exclusively for our page so those reading can have access to all the information on this page and future articles. Thank you!

Co-pays and Deductibles:
The Zombies That Won’t Go Away


By Joel A. Harrison, PhD
 
Dr. Robert Evans, one of Canada’s leading health economists, calls co-pays and deductibles zombies; that is dead ideas that just won’t go away, which is why in 1984 Canada passed the Health Act which ended co-pays, deductibles, and balanced billings (doctors charging more than the fees negotiated by the respective medical societies). The $115 million Rand Health Insurance Experiment included no deductibles, moderate deductibles, and high deductibles. It did, indeed, find that as the deductibles increased, doctor visits decreased, especially for those with lower incomes. Unfortunately, visits for both needed and unneeded care decreased alike.
 
What most people don’t understand is that doctor office visits are relatively inexpensive. Since under single-payer, administrative costs will decrease significantly for doctors, let’s hypothesize an office visit, on average, costing $50. With the effective use of teams, including physician assistants (PA) and nurse practioners (NP), many visits will be rather simple, with only some needing more than in-office lab tests. If every man, woman, and child in the U.S. were to, on average, visit a doctor twice more yearly (many of course would not; but a few would visit many times), this would add 600 million visits per year. At $50 per visit, this would add $30 billion to our annual health care bill (approximately 1.4% of our annual health care costs, $30 billion/$2.1 trillion). And many of these visits will simply assuage the fears of the so-called “worried well,” and hypochondriacs. But many will uncover problems early on, allowing for interventions that prevent more costly care down the road as well as the loss of quality of life and productivity. Getting diabetics in for a quarterly HgA1c blood test (measures average blood sugar over 3 months, much more important than daily fluctuations) and other measures as well as just discussing their diet and exercise, all done by a PA or NP, will save money. Finding early signs of cardiovascular disease will save money and lives. Getting kids in for their vaccinations and exams that may uncover developmental problems are always cost-effective. The annual savings by preventing some problems and by better maintenance of chronic problems will more than compensate for the “worried well,” and hypochondriacs.
 
Doctors offices and hospitals would have to collect the co-pays, assess if deductibles are met, all adding complexity and administrative costs. In addition, to ensure that those with lower incomes will be able to seek medical care, rules and regulations will have to be devised with artificial cut-off point and/or sliding scales which in turn will require a bureaucracy to administer, adding unnecessary costs and complications to the system. And still those needing care will delay seeking it, costing more later. Canada abolished out-of-pocket costs after extensive review of studies that clearly found both that it created a costly bureaucratic two-tier system where poorer Canadians sought less care and, as a result, led to more costly care later.
 
It may seem counterintuitive at first that co-pays and deductibles are counterproductive, leading to more costly care later on; but health care doesn’t work as a market consumer good. In addition, I think that the average person once they think about it will understand. If you buy a car with a 3-year warranty and don’t carry out standard maintenance, e.g. change the oil, etc., after expiration of the warranty, any problems that develop are on you. With single-payer health care since it is life-time coverage, the costs will be covered for more expensive conditions that could have been avoided. And if you think under our current system co-pays and deductibles work, for those un- and even underinsured who delay care, they end up clogging our emergency rooms, costing far more money which we as a society end up paying for one way or another, either hospitals closing emergency rooms because they are money losers, putting all of us directly at risk, or the burdens on those working of taking care of loved ones, and, of course, lost productivity since many of the un- and underinsured are working.

Joel A. Harrison, PhD, MPH, lives in San Diego, where he does consulting in epidemiology and research design. He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. He has lived and studied in both Canada and Sweden. 

Joel is also the author of the article:  Paying More, Getting Less - How much is the sick U.S. health care system costing you?



10:27 PM 
6 Comments
(Add Comment) |
Translate
May 31, 2009 - Sunday 

Category: News and Politics
Americans' lives depend on whether we pass the right kind of health care reform. So why is NBC News airing an infomercial that will spread dangerous misinformation?

Rick Scott is the Chairman of a group called Conservatives for Patients' Rights, and he has a history of disseminating lies and misinformation. According to the AP, Scott is "the former head of Columbia/HCA health care company who was ousted amid a fraud investigation that ultimately resulted in the firm pleading guilty to charges of overbilling." His "documentary" looks to be an extended version of videos he's been promoting over the last few weeks, which FactCheck.org characterized as "misleading" in part because they misrepresented the opinions of a doctor who actually favors the public option.

Please take action. Send an e-mail to NBC News President Steve Capus asking him not to air Rick Scott's shameful propaganda.

http://act.credoaction.com/campaign/nbc_healthcare/?r_by=4264-86673-XNlh5hx&rc=paste


12:11 AM 
2 Comments
(Add Comment) |
Translate
May 28, 2009 - Thursday 

Category: News and Politics
For those who wish to help us spread the word, please just post links to our blog posts instead of copy pasting our blogs.  Posting just the links so people read the article on our blog helps keep us in the top blogs so even more will find us.  Dr. Harrison has written articles exclusively for our page so those reading can have access to all the information on this page and future articles. Thank you!

The Supposed Difficulties of Converting to Single-Payer
By Joel A. Harrison

I’ll leave the political difficulties aside, e.g. lobbyist, bought and paid for politicians. Let's just go down the list: 
1.  We already have FICA and Medicare Taxes, so employers and individuals will just continue paying them, except the Medicare tax will be called the Single-Payer Tax and the percentage of income up to a cap will be increased. Compare this with employers having to negotiate each year with insurance companies, paying separately to them, and each year having to renegotiate, or change policies as rates spiral up. Gee, I think the former a no-brainer. 
2.  Doctors and hospitals already submit bills to Medicare and to umpteen additional insurance companies, each with numerous different policies, e.g. with different deductibles and copays. So with Single-Payer, they continue to submit; but just to Medicare, now the Single-Payer. This may be national, regional, or even by State; but now they will submit to just one entity. Gee, I think this also a no-brainer.
3.  Doctors and hospitals every year have to negotiate contracts with a myriad of different insurers. With single-payer, for instance, each specialty medical society will negotiate with one entity. The negotiations will probably be based on the Resource-Based Relative Value Scale (see article in Wikipedia http://en.wikipedia.org/wiki/Resource-Based_Relative_Value_Scale). Basically, researchers looked at all medical diagnoses and procedures and based on things like training needed, level of skill, time taken, etc. created a scale. One then decides on how much each point on the scale is worth and adjust it for cost of living differences. Just to simply, imagine an office visit is given 1 point and an appendectomy 24. One could negotiate $50 per point so an office visit would get $50 and the surgeon performing an appendectomy $1200. One can then add an additional 5% for New York City doctors because of cost of living. This isn’t the real points; but just to give an idea. Medicare and many insurance companies already use this system. So, once a year, instead of a myriad of negotiations, the medical societies, perhaps regionally, or state-wise, will negotiate with the single-payer board. Gee, once more I think this a no-brainer. 
4. An electronic database for patient records will need to be developed. The VA already has an excellent one in the public domain which could be used as a starting point. A panel could be created by our National Academy of Science to bring the best experts together to develop a user friendly version with appropriate safeguards. Then all doctors’ offices should be given computers and appropriate training, paying the doctors for their time. While this will cost money upfront, it will save tons down the line. 
5.  I am not an expert; but understand enough about databases, having created a few complex ones in Access, to know that whether one contains 1,000, 100,000, etc., once the fields are created, the data entry for additional records is not a problem. Modifications to the Medicare database can be made or see above point # 4 - Medicare will need to hire more data entry personnel and train them; but there will be plenty available who previously worked for the for-profit insurance companies.  
6.  Many current employees of the for-profit insurance companies and in the billing offices of doctors and hospitals have medical training or, at least college degrees. Those with medical training will be get jobs using them with patients. Others will need training. Well, after World War II we had the GI Bill which in many ways created our middle class and gave an enormous boost to our economy. If we could offer training, education, and living allowances to 10 million returning veterans, I’m sure we can manage with a half million or fewer who lost their jobs working in the conversion to single-payer. Remember that the GI Bill applied at a time when our national debt because of the war was enormous; but the debt added by the GI Bill shrunk as GDP grew because of it. Also keep in mind that most health insurance companies cover more than health insurance and so many of their personnel will remain. The others can be retrained for jobs that actually benefit our society rather than administrative waste that actually harms us by creating a fragmented complex counterproductive system. Some will get training as nurses, lvns, other auxiliary medical personnel, teachers, social workers, school counselors, etc. We really need more home health care nursing personnel. Many who end up in a nursing home can remain at home with the right support network. This is not only better for the patient; but cheaper. Through Medicaid we already pay for most nursing homes, under single-payer we will cover home health care, saving money and allowing many to retain their dignity and independence. 
7. All citizens and legal residents will be issued a card. In 1966 we began enrolling seniors in Medicare, 10s of millions of them. It took a couple of years altogether; but it wasn’t that difficult. With single-payer people will fill out a simple form and mail it in or, perhaps, we could just automatically mail the single-payer card to everyone registered with Social Security and just need to register children and newborns. I’m sure an efficient method can be developed. Will it guarantee we get every last person, probably not, and will it guarantee we won’t include some illegals, probably not; but neither does our current fragmented system cover everyone, in fact, we know it doesn’t with almost 100 million either un- or underinsured, and some illegals manage to get medical care. Single-payer will eventually cover everyone, and it will be easier to police for fraud.

Basically, the transition to a single-payer system will be from complexity to simplicity. Will it go smoothly? Probably not; but compared to what? Our current anything but smoothly functioning system. With proper planning it is doable. Not only will it save money, but actually simplify almost everything. Patients will choose their own doctors or hospitals. Scientific studies will be conducted to evaluate what really works, what works best, and what doesn’t work. It is currently estimated that over 1/3 of all medical interventions either are worthless or actually do harm. 

A single-payer database will actually facilitate improvements in care. Just as an example, several years ago one doctor had a patient with a very rare disorder, something he had not seen before. He just happened to mention this at a table with other colleagues and one other had recently seen the same disorder, eventually discovering several more through e-mails. They all discovered they had given their patients the same drug and reported it to the FDA. It was fortunate that the first doctor had mentioned it in the vicinity of another who also had recently seen the rare disorder because it was rare. With a single-payer database, teams will run programs to screen for rare disorders and will be able much more quickly to investigate them. Clinical trials on drugs may use several thousand patients. If severe side-effects only occur with 1 in 100,000, they will often not discover them until much later through after marketing surveillance. Using the database they can compare various surgical and medical interventions for a particular diagnosis, leading to further research. It will be easier to track errors. And patient records will be transportable. After Katrina, VA patients from New Orleans could go to any VA hospital with their complete medical records available. No way with a myriad of private insurers.

Given everything that is wrong with our current system including:
1.  Costly as percentage of GDP, taking monies that could be used for other important things such as schools, infrastructure, research and development;
2.  Difficulties in obtaining comprehensive, coordinated, continuity of care;
3. Un- and underinsured, delaying care until needing more costly care which is often too late, also clogging unnecessarily our emergency rooms;
4.  Doctors wasting up to 2 hours per day arguing with insurance companies;
5.  Those insured facing delays and denials, bankruptcy, and even loss of insurance if they lose their jobs, including as result of long term illness;
6.  Harming our international competitiveness, e.g. American manufactured car needs to add about $1600 to price because of health costs compared with Canada, France, etc.;
7. Forcing our companies to devote time and energy getting health care for their employees whereas they should be concentrating on their products and/or services;
8.  Job lock where people either stay at a job or seek jobs because of health care rather than where their skills and talents lay, thus negatively affecting productivity; and
9. Higher rate of medical errors than many other countries, lower life-expectancy, higher infant mortality, higher number of premature deaths and disabilities for treatable medical conditions.  

Many other modern industrialized nations have managed to develop some form of universal non-profit health care system with most offering comprehensive cost-effective quality care, often with far less wait than here, patient choice of doctors and hospitals, and at a lower cost. 

Gradualism, given all of the above, is just a code word for keeping the unearned, disruptive, counterproductive profits of a dysfunctional fragmented for-profit health care industry that never should have been allowed to come into being in the first place (a recent phenomenon even in the U.S. basically starting in the 1980s).  

Anyone supporting gradualism has either not really studied the problems we face (just as one example look at Barlett and Steele’s book, “Critical Condition), and all the research and studies on single-payer and international comparisons (many can be found on Physicians for a National Health Programs website at www.pnhp.org. Or is a shill for the for-profit health care industry.   

There are companies, astroturfers, hired to undermine and sabotage the exchange of ideas and opinions on public blogs (see Wikipedia “Astroturfing” http://en.wikipedia.org/wiki/Astroturfer). They throw out a “fact”, “emotionally charged words and phrases,” all to stifle, inhibit the readers focusing on the issues. While I often just google anything that seems not quite Kosher and I am trained to know which websites, e.g. National Library of Medicine, etc. to “trust,” most readers either don’t have the time or the skills. But follow a blog long enough and you can spot the astroturfers. One clue is repeating things that have already been responded to, even misrepresenting what someone else has said, and, of course, the emotionally charged words and phrases such as “government run health care” (single-payer is government financed; but delivered by the private sector), “socialism,” “choice” (under single-payer, you choose the doctor or hospital with no arguing with insurance companies), “reduction in benefits” (single-payer will cover everything currently covered by the absolute best private insurance policies and more; but eventually with research, hopefully, will remove interventions that cause more harm than good), etc. 

Don't fall for insurance industry PR or compromised "reform" that keeps insurance middlemen at the table. Support Single Payer!

Joel A. Harrison, PhD, MPH, lives in San Diego, where he does consulting in epidemiology and research design. He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. He has lived and studied in both Canada and Sweden.

Also, check out Joel's article:  Paying More, Getting Less - How much is the sick U.S. health care system costing you?


8:12 PM 
11 Comments
(Add Comment) |
Translate
May 26, 2009 - Tuesday 

Category: News and Politics

Having a baby in a single payer system.
Mon May 25, 2009 at 12:05:27 PM PDT

Canadian hippie pinko socialist here....Just wanted to outline one of the major life events in Canada's single payer universal healthcare system for comparison purposes.

My littlest child, my darling pumpkin is going to be three in August.
Here she is in a picture I took just a couple months ago. (she's rather pale too!)

I suspected I was pregnant and confirmed it with a home pregnancy test,  then booked an appt with the doctor the next day.

My own doctor that I chose btw. One of the talking points from the Insurance lobby is that in a socialized system you are not allowed choose your own physician.

At the first visit the doctor also confirms the fact, and fills out the proper forms with questions about health and past history, family history etc...and orders a battery of tests.
When you go to the Dr they will take your medical number off your card. (My clinic knows me and has it on file. I never have to show it there)

Cost: $0

There is no pre pay receipt to send in, or co pay.

Follow up appointments are once a month until the last month, barring there are no complications. I am an older mom (shush!)  so I was watched a bit more closely for things that have been an issue for me in the past, including high blood pressure. The last month during a pregnancy, they book weekly visits.

An Ultrasound is requisitioned usually within 6-8 weeks to ensure that things are going properly and that it is not an ectopic pregnancy etc.

Cost: $0

Usually a doctor will not order more of these unless warranted, again I have had complications in past pregnancies and several more were done through the course of the pregnancy, including two in the city. I live in a small community in the stix, so it is a long travel including a ferry to get to specialized care. We have basic ultrasound at our local hospital, which is fine for most things. But the more detailed scans were needed for a particular bone disorder that we were watching for.

Cost: $0

Ferry fare: paid for through a medical assistance travel program. A form can be obtained from the Doctors office with the physicians number on it, and then called into an automated service. They give a confirmation ID number, and then that form is presented at the toll booth at the ferry. (can also be used for bus service in other areas.) There is no need for the patient to lay out the costs to be reimbursed later.

Other tests were offered including amniocentesis, but since I wouldn't actually do anything different if I was found to be carrying a child with Downs or something like that, it seems rather pointless when one considers the risks that are also involved. (Every medical procedure involves some sort of risk.) These tests would have also been cost free.

Gestational diabetes: Diet controlled, I had been to the dietitian during previous pregnancies and there are clinics that one can attend to help with this. I was able to keep almost perfect sugar levels. (Except for one or two pizza nights. Errr and Easter chocolate..Oh baybay!)

There are no costs to attend these clinics, and they will give you a sugar monitor and teach you how to use it properly. Future supplies such as the strips can be reimbursed by pharmacare, by sending in your receipts. This is based on income.

A week before the due date, my water broke but nothing else happened that day. I was booked into the hospital the next day to be induced. (there is a 24 time limit to go into labour, or infection may set in) By noon I was on the drip, by 6:45 that evening I had a beautiful little baby in my arms. 6lbs 6oz, so just right for a week preterm.
There were some complications from something that can be life threatening, it is called placenta previa and a D&C followed. I was also taken by helicopter ambulance to the city as they thought there may need to be an emergency hysterectomy because of some severe hemorrhaging, it was thought that it was best to be in a larger more equipped hospital.

All was ok though.

Total cost for the pregnancy including the ambulance and glucose test strips: About $150.00. I was not made to wait in any lines, all my referrals were almost immediately attended to.

Follow ups: If all is well with baby and mum, there is a follow up once a week for the first couple weeks. We have community nurses who are based at the community Health units, and usually will come to see you in the hospital and arrange to come by the home once a week. (Of course this is voluntary.) They weigh and measure the baby, answer any questions, and also gently monitor whether the mum is having any emotional difficulties such as post partum depression. (THIS IS IMPORTANT to ensure there are no problems and that the baby is thriving. Proactive and preventative care!) Mums are encouraged to call if there are any concerns. This is invaluable for new mothers. I am an old hand at mommyhood, and still had at least three visits.

Immunizations for babe are booked at the health unit to be given by the nurses starting at 18 weeks. (And paid for by healthcare) Every community in my province has a health unit, the nurses also go to schools and talk to the kids about diet, smoking risks, drugs, sexually transmitted diseases and contraception. (There is an opt out for parents to sign if they do not wish for this. Not too many parents do so.)

Canada's infant mortality (5.4 per 1000 births. 2006 numbers.) rate is lower than the US, (6.9 per 1000. 2006 numbers) yet still higher than many other countries. This can possibly be due to the way that infant deaths are classified and recorded.

My family's (Me, my husband and two of my younger children. My older kids are covered under their fathers union paid extended medical/dental.medical) costs are $108.00 per month.
Part of healthcare should be prevention and education, and I would say that this system meets all of that quite nicely.
In a bizarre twist, just as I was writing this; the Doctor's office called to book my yearly physical.
I saw an advertisement paid for by the Insurance industry on CNN the other day that said a woman in Canada was denied a pap test and that she had cancer that was found too late. I have no idea where they got that from, because it's surely not the way Universal healthcare works here in BC at least. (even pap tests that are ordered every six months because cell changes were found in the last one are covered. This I know for sure.) There were a couple incidents where women in New Brunswick were denied a pap test, but that was because of their doctors own religious claptrap. That same old bullshit pops up here too.

And that's about it. I have lived my entire life under this system, and although it is not perfect and is always open to improvement, I would not give it up without a fight.

These are my own experiences here in British Columbia, other people's experiences may differ.

6:05 AM 
11 Comments
(Add Comment) |
Translate