May 13, 2012

The underside of employer wellness programs.

Comment by Don McCanne of PNHP: Altruistic employers who, out of the goodness of their hearts, offer wellness programs to their employees, also theoretically benefit by improving productivity through having a healthier work force. These are admirable goals. But employers are now playing the blame game as they use their programs to penalize employees who have medical needs, by reducing their health care benefits and increasing financial barriers to care.

Employers can enhance employee health through work-sourced exercise and nutrition programs, through work safety measures, and through programs such as smoking cessation. In sharp contrast, disease screening should be provided privately in an entirely separate primary care environment where the screening is a part of a comprehensive, integrated health care program that belongs to the patient, not the employer.

Above all, whereas the medical health status of employees should be maintained through the health care delivery system, never, never should the employer be allowed to reduce health care benefits because the employee has greater needs.

This is yet one more reason why health insurance should be totally dissociated from employment. If we had an improved Medicare that covered everyone, health care access would be continuous throughout life, and barriers to care could never be used to punish individuals unfortunate enough to have manifested or contracted medical problems.

May 10, 2012

Legislation Introduced to Make Health Care a Right in New York State

Single Payer New York
Physicians for a National Health Program
Health-care NOW! - NYC

For Release: May 8, 2012 - NOON (LCA press conference)
For More Information: Mark Dunlea, 518 860-3725

Legislation Introduced to Make Health Care a Right in New York State

Doctors, Nurses, Patients Advocates Applaud Updated Single Payer Medicare for All Legislation by Gottfried, Duane and 70 lawmakers

Doctors, nurses, patients, senior citizens, anti-poverty advocates, faith leaders and medical administrators joined Assemblymember Richard Gottfried and Senator Thomas Duane in unveiling an updated and revised single payer legislative proposal for New York State . More than 70 state lawmakers are cosponsors

Assemblymember Gottfried had initially drafted a single payer plan for New York in the early 90s. The revised legislation incorporates changes that have been made in the state's oversight of health care in the interim, advances in how to provide medical services, and the recent federal changes in the health care system. The legislation builds upon the momentum from last May when Vermont became the first state to enact a universal health care system which the Governor plans to make a single payer system, where on programs pays all bills.

“The current system doesn’t work for patients or health care providers, or for the employers, individuals, and taxpayers who pay for care and coverage today,” said Assembly Health Committee Chair Richard N. Gottfried, author of the bill. “We can get better coverage, get all of us covered, and save billions by having New York provide publicly-sponsored, single-payer health coverage, like Medicare or Child Health Plus but for everyone.”

“Our current health insurance system is driven by uncertainty. Will my family have coverage? Can we afford it?,” said Senator Duane. “Single-payer is about removing that fear from peoples’ lives. It will allow all New Yorkers the same comfort that our seniors get from Medicare, and that our veterans get from TRICARE. It will allow entrepreneurs to worry about product innovation, not health insurance costs. It is time for single-payer in New York .”

Joining Assemblymember Gottfried and Senator Duane at the press conference were Katie Robbins of Health-Care Now!, Vito Grasso, Executive Vice-President of the NYS Academy of Family Physicians, Dr. Asiya Tschannerl of Physicians for a National Health Program, Mark Dunlea of Single Payer NY / Hunger Action Network of NYS, Shaun Flynn of the NYS Nurses Association, and Rev. Bebb Stone.

Assemblymember Gottfried convinced lawmakers four years ago to fund a study of the most cost-effective way to provide health care to all New Yorkers. The answer was single payer, which would reduce overall health care expenditures in New York by $20 billion annually by 2019. The state study said that single payer would be $28 billion cheaper annually by 2019 than the insurance mandate enacted by Congress. In addition to saving money, single payer was the only plan that guaranteed that everyone would have access to health care services.

"The Presbyterian Church U.S.A. has called single payer health care reform 'a moral imperative' since 2008. If I want health care coverage for myself ( and I do), how can I not want it equally for my neighbor whom I am commanded to love as myself?" asked Rev. Bebb Stone. "We believe that the value of persons requires that each person have full access to essential services without regard to ability to pay and on terms that enhance the dignity of the individuals" according to the 2008 resolution.

"Even if the recent federal health insurance mandates survives the legal challenges, it fails to provide health care coverage to everyone and is financially unsustainable. Tens of millions of Americans will discover that the insurance they are forced to buy fails to pay for the health services they will need. Everyone knows that there is a better solution - single payer, expanded and improved Medicare for all - and New York should be the first one to put it in place," said Mark Dunlea, Executive Director of Hunger Action Network.

"The simplest and quickest way to reduce health care costs is to eliminate the money wasted on health insurance, its profits and administrative costs, and the bureaucratic barriers it presents to health providers and consumers. If we got rid of insurance companies nationally, the annual savings would be more than $400 billion," added Dunlea, chair of the state legislative committee of Single Payer New York, an umbrella organization.

"As a physician working in the Bronx , I see every day the profound limits of medicine when patients must ration their care due to high copays and deductibles," said Dr. Asiya S. Tschannerl with Physicians for a National Health Program. "And too many patients have told me that they earn just a few dollars too much to qualify for Medicaid, and are now facing the horrible dilemma of - "do I reduce my income? or go without insurance since I couldn't afford it." Enough is enough. We need a truly universal healthcare system like every other industrialized nation on this planet. Healthcare is a human right, not a privilege! A Single Payer expanded and improved Medicare for all would guarantee healthcare for all," added Tschannerl, a member of Doctors for the 99% and Occupy Wall Street.

"We must end funding the waste, greed, and corruption of the health insurance companies, and move these resources to funding and providing actual healthcare. Insured or not, the Affordable Care Act pits people's needs against profits for corporate-run healthcare. We can reverse this trend and recognize the right to healthcare by implementing the New York Health bill," stated Katie Robbins of Healthcare-NOW! NYC.

"The Nurses Association firmly supports the establishment of a more equitable coverage system that directs scarce healthcare dollars towards providing universal access to high quality, cost-efficient health care for all New Yorkers - regardless of their age, income, health or employment status," according to Deborah Elliott, RN, MBA, Deputy Executive Director, New York State Nurses Association.

May 8, 2012

Health care costs have DOUBLED over the past ten years

All while the average person's income is shrinking.

http://www.mcclatchydc.com/2012/05/07/147985/health-care-increasingly-out-of.html#storylink=cpy

Tens of millions of adults under age 65 – both those with insurance and those without – saw their access to health care worsen dramatically over the past decade, according to a study abstract released Monday.

The findings suggest that more privately insured Americans are delaying treatment because of rising out-of-pocket costs, while safety-net programs for the poor and uninsured are failing to keep up with demand for care, say Urban Institute researchers who wrote the report.

Overall, the study published in the journal Health Affairs found that one in five American adults under 65 had an “unmet medical need” because of costs in 2010, compared with one in eight in 2000. They also had a harder time accessing dental care, according to the analysis based on data from annual federal surveys of adults.

<snip>

RAND’s Kellermann noted that even as the nation’s total health care bill doubled in the past decade to $2.6 trillion, many Americans had difficulty getting treated.
“We’re paying more and more and getting less and less,” he said.


Asked if there was any good news in her report, Kenney said that in contrast to adults, millions more children gained access to care in the past decade, likely because of the availability of public coverage for children through Medicaid and CHIP. The study found the percent of children who had been to a doctor in the past year rose to 92 percent in 2010, from 89 percent in 2000.

May 4, 2012

Bad Case of PIISD: Private Insurance Induced Stress Disorder

AA psychiatrist diagnoses victims of health insurance

http://www.commondreams.org/view/2012/05/02-5?print

In July 2009, Carol A. Paris, a psychiatrist and an advocate for a single-payer national health care system, found herself on a speakers panel with Donna Smith of Aurora, Colo.

Smith and her husband, Larry, had been featured in the 2007 Michael Moore movie "Sicko." After Larry Smith was diagnosed with chronic coronary disease and Donna Smith contracted uterine cancer, they couldn't keep up with the costs of health insurance. They were forced to sell their home in South Dakota and move into the basement of a daughter's home in Colorado. Moore took them to Cuba for treatment.

"I heard her talk," Paris said, "and I thought, 'That's an amazing story.' I see patients every day being pushed around by the health insurance industry and that story just pissed me off."

The more she thought about it, the more she realized that people dealing with health insurers exhibit some of the same symptoms as patients with post-traumatic stress disorder.

April 28, 2012

Medicare is NOT bankrupt!

Understanding the Medicare Trust Fund

In their recently released report, the Medicare trustees have projected that the Part A trust fund, also known as the Medicare Hospital Insurance (HI) trust fund, will remain solvent through 2024. This is the same conclusion that the trustees made last year. Reforms included in the Affordable Care Act (ACA) have strengthened Medicare’s financial outlook and extended solvency through 2024.

The Part A trust fund and its solvency are frequently misunderstood. The trust fund is a financing mechanism for Medicare Part A, which covers inpatient services such as hospital stays and skilled nursing facility care. The trust fund is financed through a combination of payroll taxes and other revenues. Although, as noted above, the trustees have recently reported that the trust fund is solvent through 2024; that does not mean that the trust fund or Medicare will cease to exist in 2025. The trustees found that the Part A trust fund will be able to cover 100 percent of the costs of Medicare’s Part A benefits through 2024. After 2024, the trust fund will still be able to provide coverage, though at a lesser rate. According to the Center on Budget and Policy Priorities (CBPP), starting in 2025, Medicare will still be able to cover 87 percent of all inpatient costs, and over the next 75 years, the trust fund, on average, will be able to cover 74 percent of Medicare’s inpatient costs. A number of factors can affect the Medicare Part A trust fund. For example, since the trust fund is partially paid for through payroll taxes, an economic downturn could result in less people paying into the system. As the economy recovers, so will the trust fund.

Medicare Part B, which covers outpatient services such as visits to doctors’ offices, and Medicare Part D, which covers prescription drugs, are financed through beneficiary premiums and general revenues, not through the trust fund.

While action will need to be taken to make up for the future financing shortfalls of Medicare Part A after 2024, it is important to recall that congress has been taking this kind of action since 1970 to extend the life of the trust fund to ensure that people with Medicare are able to access affordable, comprehensive and quality coverage. Unfortunately, supporters of drastic changes to Medicare, such as premium support, point to the potential insolvency of the trust fund to justify proposals that would shift substantially higher out of pocket costs onto beneficiaries and their families as well as undermine the consumer protections and guaranteed benefits that the Medicare program currently provides. Strengthening the Medicare trust fund can be done without gutting Medicare’s guarantees.

Read Medicare Rights President Joe Baker’s statement on the release of the 2012 Medicare and Social Security Trustees Report.http://www.medicarerights.org/newsroom/pressreleases/2012_16.html

Read the Center on Budget and Policy Priorities report, “Medicare is not Bankrupt.”http://www.cbpp.org/cms/index.cfm?fa=view&id=3532

Read the Center for Medicare and Medicare Services press release and Trustees Reporthttp://www.medicarerights.org/newsroom/pressreleases/2012_16.html

April 27, 2012

Wellpoint eliminates plans with a higher than average number of sick people

Comment by Don McCanne of PNJP: What is a private commercial insurer to do when when one or more of their plans has thousands of members with expensive health issues? Walk away, of course. That's exactly what WellPoint did with its expensive plan membership in Northern California.

What else can you expect from a private, for-profit health insurer? It is first and foremost a business, which must never allow its role of patient service to interfere with its profit mission.

Insurers providing Medicare Advantage plans are prohibited from exercising favorable selection - cherry picking, cream skimming, or whatever - but what do you call it when they dump an entire plan population of sicker than average patients? That's worse than cherry picking individuals because that involves an entire plan population.

The plans have figured out how to cheat on the Medicare adjustments for adverse selection when their patients are actually healthier and less expensive than average. They just haven't figured out how to cheat when their patients are less healthy. They certainly don't want to make them look healthier which would then adjust downward their payment rates. No, walking away from their sicker populations seems to be their only answer.

And what is the Obama administration doing about this? Not only do they let them walk away from high-cost populations, they also are rewarding these overpaid plans with extra "quality award" money - a phony guise since these awards are going to almost all plans regardless of how mediocre their quality scoring. This is really a money allocation scheme designed to enable plans to offer extra benefits in order to entice patients away from the traditional Medicare program. Numerous releases from HHS have bragged about the increased enrollment in these private Medicare Advantage plans. Why are they promoting and awarding such a despicable industry?

President Eisenhower warned us about the military-industrial complex. Arnold Relman warned us about the medical-industrial complex. But what about the government-private insurer industry complex. That one is killing us... literally.

My comment: "But what do you call it when they dump an entire plan population of sicker than average patients?" Lemon dropping.

April 13, 2012

Is HHS serious about controlling insurance premiums?

Comment by Don McCanne of PNHP: Buck Consultants has completed a survey of insurers and administrators showing that each and every form of employer-provided health plan is projecting cost increases of 9.9 percent. Is it a mere coincidence that all of these increases are just below the 10 percent threshold for subjecting insurance premium rate increases to federal government review?

Even though many employers self-fund their plans, the 9.9 percent figure supposedly represents projected increases in total medical plan costs for this year, and not just increases in health care costs. In recent decades, health care spending has increased at rates about 2 percent higher than the growth of GDP which ideally grows at a rate between 2 and 4 percent. The combined total is still less than the increases in insurance premiums, now pegged at about 9.9 percent.

How long can we anticipate having government-sanctioned 9.9 percent annually-compounded private insurance rate increases?

Regardless, isn't it time that we eliminate employers and private insurers as intermediaries in our health care financing? We would give ourselves a much better deal through our own public financing system.

My comment: No wonder MA still has 50% of its bankruptcy cases caused by health care expenses.

April 1, 2012

Health Care Reform—the Charade of Regulation

Advocates of HCR claim that a fresh new regulatory regime will control costs to the point where imposing mandates on everyone to buy overpriced underinsurance would be justified. This claim rests mainly on four features—

• An end to refusing policies and price discrimination for people with pre-existing conditions
• An end to recissions of existing policies when people get expensively sick
• Immediate sunshine on price gouging to discourage excessive price increases by insurance companies through review and disclosure of insurance rate increases
• Requiring premium refunds if insurance companies exceed a specified medical loss ratio (MLR)

Unfortunately, none of these proposals, however helpful in and of themselves, will have any effect whatsoever on controlling health care costs.

Ending pre-existing condition discrimination

There is nothing in the legislation to restrict insurance companies from using this as a justification to jack their premiums sky-high for everybody. Older people can be charged 3 times more, and age certainly has to qualify as a pre-existing condition. Also, there is no mention of what recourse you have should you be turned down for, say, having a bad credit record.

Ending recissions

That would be nice, and I really wish that the legislation as written actually said that. What it does say is that recissions will be eliminated except in the case of fraud. Can somebody please explain why the insurance companies will not be able to drive a whole fleet of very large trucks through that loophole? And there is no mention of what happens when you get dropped because you are unable to afford the premium one month.

Another huge problem is that it leaves regulation to the states, which for all practical purposes is not regulation at all. California has a law against recissions already, but they are not enforcing it at the moment because they can’t afford to.

The sunshine provision

It’s astonishing that anyone could call this regulation and still keep a straight face. What it amounts to is a list of very naughty boys and girls. And they’d better watch out, because if they don’t straighten up and fly right, they’re going to wind up on that very same list again next year.

Medical loss ratio requirements

Unfortunately, 15 states either have these requirements now or have had them in the past(1), and they have not had even the slightest effect on escalating health care costs. Of course it’s helpful for some people to get premium rebates, but despite that, the cost of premiums keeps on skyrocketing, 45,000 a year keep dying for lack of the money to pay for health care, and 300,000+ keep going bankrupt due to medical bills (the majority of whom had insurance that was mostly better than the strictly catastrophic "bronze" underinsurance that will be mandated under “reform”).

Locking the barn door after the horse gets away is not regulation in any sense of the word, as demonstrated by the following real life example.

Dear Mr. and Mrs. Sarkisian:

We were sorry to hear that your daughter Nataline died because CIGNA denied your claim for her liver transplant. However, you will be glad to know that we have analyzed CIGNA’s medical loss ratio and that all of their customers are entitled to premium refunds. Isn’t that wonderful?

Yours truly,
Dr. Pangloss

Another possibility—allowing lawsuits against insurance companies for claims denial

HCR does not have any restrictions whatsoever against denials of particular claims, and it is this practice that is a major cause of so many deaths and bankruptcies. People are not allowed to sue companies for denying claims. Representative Jim McDermott (WA-07) is drafting an amendment which would allow such lawsuits. I think it’s a very good idea, but it suffers from the same problem as attempting regulation by mandating specific medical loss ratios—the remedy comes too late to do any good. Mr. and Mrs. Sarkisian would undoubtedly appreciate the money if they sued CIGNA and won, but they would surely prefer that their daughter had gotten the treatment she needed in the first place.

In addition, legal remedies generally increase health care costs. This is already true of medical malpractice lawsuits (even though the cost increases as a cause of our high per capita medical costs are vastly overrated by the tort reform crowd). In no other developed country do people constantly make use of the legal system to get the money needed to pay for the ongoing medical bills necessitated by poor medical outcomes. Note that this motivation to sue is exactly the same regardless of whether or not such outcomes were caused by actual malpractice. The reason for this is that those extra costs are automatically paid by societies which guarantee health care as a right, and therefore there is no need for anyone to initiate a tort lawsuit in order get the money to pay them.

(One of the reasons that we lead the developed world in medical error rates(2) is that private employer-based insurers are constantly forcing people to change providers with their endlessly mutating preferred provider lists. Nothing in the proposed legislation deals with this issue.)

Real regulation

Because the largest risk pools will always be the cheapest, health insurance will always trend toward being a monopoly. Wherever natural monopolies exist, society absolutely must regulate them so that citizens do not get ripped off for huge sums of money. We learned this more than a hundred years ago with respect to electrical power grids. At that time, many publicly owned utilities were established and the remainder were put under strict regulation by public utility commissions. When historical amnesia finally set in during the last years of the 20th century, deregulation insured that Enron and Reliant were able to rob energy consumers on the west coast of billions of dollars during a fake “energy crisis”. The corporate-controlled media rarely pointed out that cities with municipally owned utilities didn’t have any brownouts during the “crisis”. All American health insurance companies are Enron. Just as Enron withheld energy from the market to drive up prices and profits, so do insurance companies deny care in order to increase profits.

There is no such thing as health care reform without strict regulation of health care costs. It can be done by outright government ownership of the health care delivery system (Britain, Scandinavia), government monopoly of health insurance (Canada, Taiwan), or strict government regulation of private insurance (the Netherlands, France, Japan). The third method can certainly work as well as the first two in practice—too bad that nothing in current “reform” comes remotely close to that.

Real regulation of mandated private insurance in the Netherlands results in policies that cost 100 euros/month/adult ($95-$145 depending on exchange rates), with no deductibles, no co-pays and no age rating. In addition, many countries regulating private health insurance also directly control provider prices. In 1996, my husband got an emergency root canal in the Netherlands for 100 guilders, or $25 American. In Japan, an overnight hospital stay costs the equivalent of $20. And yes indeed, the number of zeros in those prices are perfectly correct, though they could probably stand to be raised and in fact may have been by now.


(1)http://www.familiesusa.org/assets/pdfs/medical-loss-ratio.pdf
(2) http://www.truthout.org/111908HA

March 27, 2012

PNHP statement on the Supreme Court deliberation of the Affordable Care Act

http://www.pnhp.org/news/2012/march/health-law-constitutional-or-no-fails-to-remedy-ailment-doctors-group
Physicians for a National Health Program
March 26, 2012
Press Release
Health law, constitutional or no, fails to remedy ailment: doctors group

Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.

Why? Because the ACA perpetuates a dominant role for the private insurance industry. That industry siphons off hundreds of billions of health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable reforms in Massachusetts and other states have worked over the past few decades. They have invariably failed our patients, foundering on the shoals of skyrocketing costs – even as they have profited the big private insurers and Big Pharma.

The Supreme Court’s ruling is not expected until June. Regardless of how it rules, we cannot wait for an effective remedy to our health care woes any longer, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an expanded and improved Medicare for all.

March 26, 2012

There is no federal control over increases in health insurance premiums

Commentby Don McCanne of PNHP: The title of today's message, "Controlling costs through HHS rate reviews," is deliberately deceptive to make a point. Supposedly, the Affordable Care Act (ACA) was designed to help control spending in health care, and the insurance premium Rate Review process was a component of cost containment. In fact, not only does the process have no impact on health care spending, it doesn't even have any federal control over increases in health insurance premiums.

ACA regulations require that any plan with premium increases of 10 percentor more be reviewed. Although states may have some influence over rate increases, the federal government has no authority to do anything about the increases other than expose the insurers to public ridicule.

In the last six months, 20 rate increases reviewed by the federal government have been found to be unreasonable, primarily because they exceeded the 20 percent of the premium that they could use for
administrative services and profits. Many of these insurers in the individual market will find that their inefficiencies are so great that they will be unable to comply with this requirement, so they really don't
need ridicule to drive home this point.

In the meantime, insurers will be able to increase their premiums 9.9 percent each year with no questions asked, at least not by the federal government. Compound that rate over several years, and then where will we be?

Obviously this ACA measure to "control costs" will have very little impact, if any, on insurance premiums and absolutely no impact on total health care spending.

There is a much more efficient model of health care financing that actually would slow the increase in health care spending while ensuring health care for everyone. Instead of playing ACA games, we should move forward with an improved Medicare for everyone.