Yes, Dr. Don McCanne is right. “Let’s have the members of Congress fire the insurers and set up our own national health program – an improved Medicare that covers everyone. If they won’t do that then let’s fire them, replacing them with responsible elected stewards who will. ”

Blue Shield, Kaiser among state insurers fined

State regulators Monday fined seven of California’s largest health insurers nearly $5 million for systematically failing to pay doctors and hospitals fairly and on time.

The California Department of Managed Health Care issued the fines following an 18-month audit in which investigators looked at a small but statistically significant sample of claims. The investigation found the plans were paying on average about 80 percent of the claims correctly, far below the legal threshold of 95 percent.

“Our clear and consistent message is that California’s hospitals and physicians must be paid fairly and on time,” said Cindy Ehnes, director of the Department of Managed Health Care, which is charged with regulating the states’ health maintenance organizations, or HMOs.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/11/30/BUSR1GJ01V.DTL

Nov 26, 2010, 12.00am IST Joseph Stiglitz, the Nobel prize-winning economist has written several articles on the inequity in access to health and the flaws in the drug discovery process of pharmaceutical companies. On a recent visit to Delhi, Stiglitz spoke to Rema Nagarajan about the negative role of patents in drug discovery and the pitfalls of private insurance in health:

Why have you been pitching for a single payer system for health insurance rather than a system where several private companies compete?

The US model of private health insurers has been proven inefficient and expensive. Rather than provide better healthcare at lower costs, insurance companies innovate at finding better ways of discrimination. They are inefficient because they are trying to figure out how to insure people who don’t need the cover and keep out people who need it. With many companies, they also need to spend on marketing and advertising. The incentives are all wrong and the transaction costs are very high and you have to give them a high profit. In health, social and private incentives are totally disparate. Competition does not work in healthcare especially in the health insurance market. Several countries like the UK, France and Sweden have a single payer system, differing only in the organisation of healthcare delivery.

Several health insurance companies are setting up business here. Should India be worried?

India would be in a terrible mess, given the size of its population, if it went down the wrong route (of private companies for health insurance). They should learn from the mess that the US has got into. Once the companies start making profits, special interests in politics will come into play and it will be difficult to get them out. In India, given the disparities in income, a single system for delivery might not work. So, it will probably need a mixture of public and private provision or maybe public healthcare for basic clinics and reimbursement for others, or the UK model where provisioning or delivery is also through public institutions.

Are you against intellectual property especially in health research into medicines?

I am not against intellectual property (IP). But the benefits of IP have been exaggerated and the costs underestimated. IP creates monopolies. And it does interfere with economic efficiency by interfering with the flow of knowledge and the use of knowledge, particularly for developing countries. The TRIPS (trade-related aspects of intellectual property rights) agreement is trying to impose the same IP framework on everybody. The question is whether IP promotes innovation. Increasingly, the evidence is that it may actually impede innovation. It is leading to infinite negotiations around patents. More money is being spent on lawyers than on research. New ideas are the most important input into research. IP is making that input difficult to get. We need some IP. But we also need to find better ways of financing and incentivising research such as government-sponsored research.

Is it viable for governments to finance drug research?

Yes, public financing of drug research is financially viable. In a system where government pays for drugs, it is in effect, the government or the public who pay for hugely expensive drugs. Drug companies greatly exaggerate the cost, especially on research. If you broke down their costs, you would see that basic research is done by the government. The applied research of a particular molecule is mostly done by small companies, often linked to universities, which is still private. But the biggest cost is testing of the drugs and that is usually blown up and often includes promotion costs.

Read more: ‘The US model of private health insurers is inefficient, expensive’ – The Times of India http://timesofindia.indiatimes.com/home/opinion/edit-page/The-US-model-of-private-health-insurers-is-inefficient-expensive/articleshow/6989634.cms#ixzz16PtCsOMh

But it does not. It makes no more sense to let people’s house burn down because they cannot pay their fire-department fees — maybe they chose the wrong “plan”? or a plan with a deductible they cannot afford? – than to let them die because they cannot afford their health care.

Now, why the new federal law, the Patient Protection and Affordable Care Act P-PACA), will fail to keep its two key promises (protecting patients and making health care affordable), is not the topic of this posting, because I and many others have commented on it extensively elsewhere.

Rather, it is to point out that if we continue turning health care more and and more into a “consumer good” that those who have the ear (and pockets) of Congress and the White House can make a profit off of (and P-PACA reinforces the trend ), we are up to extremely unpleasant experiences.

Such as, for instance, looking at our homes burn down while the Fire Department watches. And unfortunately, this nightmare is already with us. It happened just a few days ago, in Tennessee.

Here is a video clip produced by Newsy.com, illustrating the story and the debate it ignited in cyberspace:

“No pay, no spray”.

Interestingly, one reporter critiques the city implementing the fee because it likens a public service, fire protection, to auto insurance (note: remember the comparison made by President Obama  between health insurance and auto insurance, once even the token gesture, the ‘public option’, towards his progressive base had been cast aside to give full way to the Well Point-crafted federal legislation?)

And here is how the episode is described in Amy Goodman’s show, Democracy Now:

Tenn. Fire Department Allows Home to Burn Down over Unpaid $75 Fee

In Tennessee, a local fire department refused to put out a house fire last week because the homeowner had forgotten to pay $75 for fire protection from a nearby town. The firefighters showed up to the scene of the fire and then watched as the home of Gene Cranick burned to the ground. Cranick’s neighbors had paid the $75 fee, so when the fire spread across the property line firefighters took action, but only to save the neighbor’s property.

The local mayor defended the actions of the firefighters. South Fulton Mayor David Crocker said, “Anybody that’s not in the city of South Fulton, it’s a service we offer. Either they accept it or they don’t.” On Monday, Gene Cranick appeared on Countdown with Keith Olbermann.

Gene Cranick: “Everything that we possessed was lost in the fire. Even three dogs and a cat that belonged to my grandchildren was lost in it. And they could have been saved if they had been—they had put water on it. But they didn’t do it, so that’s just a loss.”

Keith Olbermann: “When you all called 911, as I understand it, you told the operator you’d pay whatever was necessary to have the firefighters come put out and prevent the fire from spreading to your house. What was their response?”

Cranick: “That we wasn’t on their list.”

Are we going to watch in disbelief while our homes burn down?

As Dr. Bill Skeen, executive direction of Physicians for a National Health Program-California, wrote:

Sadly, those of us who believe healthcare is a right know that this country has never assumed the mantle of providing healthcare to all its residents. Currently we leave 50 million of our brothers and sisters uninsured; 45,000 of them die each year because of it. It is time for us to stand up and demand that our nation return to the real American values of empathy and compassion and caring about our neighbors’ wellbeing.

Last night we as a nation let a family’s house burn to the ground while those who could save it watched and did nothing. Everyday we let more than a hundred people die who have no health insurance. Are we willing to standby and do nothing to stop it?

We don’t need to. And we mustn’t.

Let’s pick up the phone and call our U.S. Representatives today, and tell him or her to co-sponsoer HR676 when it is reintroduced next year in Congress. Tell him or her that you are outraged at what happened in Tennessee and that these two issues, fire protection and health care for all, are one and the same at their core. They demonstrate the incontrovertible need for government to protect the common good, and for we Americans to show our humanity to each other.

The Capitol Switchboard at 202-224-3121 / 202-224-3121  can connect you to the office of your Representative.

See below for a list of US Representatives that demonstrated their support this year for single payer by co-sponsoring HR 676. Please thank those legislators for their support, and urge the others to get on board!

Let us demand Medicare for All – everybody in, nobody out!

Name                                  State    District    Date signed
Rep Woolsey, Lynn C.        CA        6             01/26/09
Rep Miller, George             CA        7             03/19/09
Rep Lee, Barbara               CA        9             01/26/09
Rep Honda, Michael M.      CA      15             02/11/09
Rep Lofgren, Zoe                CA     16             05/20/09
Rep Farr, Sam                    CA      17             01/26/09
Rep Berman, Howard L.     CA     28             01/26/09
Rep Becerra, Xavier           CA     31              03/17/09
Rep Chu, Judy                   CA     32              07/31/09
Rep Watson, Diane E.        CA    33              01/26/09
Rep Roybal Allard, Lucille   CA    34             03/30/09
Rep Waters, Maxine           CA    35             03/19/09
Rep Napolitano, Grace F.   CA    38             01/26/09
Rep Baca, Joe                   CA    43              10/07/09
Rep Filner, Bob                  CA    51              02/11/09

“If it looks like a rat, walks like a rat, and smells like a rat…it is likely a rat!”

And this is the problem with those who puzzle about the response of ordinary Americans to the “Patient Protection and Affordable Care Act” (PPACA), recently signed into law. Those folks are trying to figure out the “riddle” of the “ambivalent” response of Americans to the law. “What is it with these folks (ordinary Americans) that they can’t recognize what is good for them?”, they wonder.

Yet as I, and so many others, have argued repeatedly, the law fails on its two key promises:

1) It does not seriously protect patients from the financial burden of disease — in fact, it does not even promise to, certainly not to the 23 million who, according to the Congressional Budget Office (CBO), will remain uninsured by 2019.

2) It fails to make health are affordable, both to the nation (taxpayers) and to individuals. Indeed, according to the CBO, the law will actually increase federal health care expenditures, even as it “covers” around 32 million folks with shoddy policies that can pay as little as 60% of covered services (for the uncovered services, you’re on your own, as you have always been!).

Not to mention the out of pocket costs for individuals and families, that continue, and will continue, to increase as I type and you read this posting…

And Americans are no worse than other peoples when it comes to sensing bait and switch approaches, and smelling rats, which government officials from both parties, attempt to sell as something else, as they insist on insulting our intelligence (maybe they hope that if you repeat lies or distortions enough the public will be convinced that they are “facts”).

So stop scratching your head, pollsters, and trying to figure out what in the “message” has failed to convince Americans about PPACA.

“It’s the content, stupid!”

Trudy Lieberman makes an excellent point about precisely this issue, so I am copying her analysis in its entirety.

Distrust and Health Reform, by Trudy Lieberman

A fine piece last Wednesday by Politico’s Carrie Budoff Brown dissects what political prognosticators from Bill Clinton to Obama pollster Joel Berenson had predicted about the ultimate acceptance of health reform legislation. “Rarely have so many political strategists been so wrong about something so big,” she writes. “At the six-month mark, the law remains a riddle for political analysts, lawmakers and the White House.”

Riddle? Not really. Months ago the public sensed a bait and switch, and the media weren’t helping them out. The seeds of the public schizophrenia over reform were sown during the presidential campaign, when candidates Obama and Clinton talked about universal health care, making it seem that the country was on the verge of adopting a true national health insurance system like the rest of the developed world.

That’s not what they had in mind, and universal health care morphed into universal coverage provided by private carriers. Then the pols and the press discarded that term when the rationale for reform became insurance market reform—a snoozer for sure.

The constant bashing of insurance companies by the president, his health secretary Kathleen Sebelius, and advocacy groups did not compute with the public. Many Americans have had wicked experiences with insurers—but if they are so evil, why give them twenty-five million new customers? At the gut level, that didn’t make sense, and media explanations about bringing everyone into the risk pool didn’t resonate. But probing further would bring up the nasty, controversial subject of the individual mandate—the requirement that everyone have insurance. The pols were not eager to talk about the central feature of the legislation, and the press didn’t discuss it much either.

If they did, that might have raised another better-to-ignore topic, affordability: whether middle income folks would really be able to afford a policy they will be required to buy, even with government tax credits to help pay the premium. Last week I interviewed twenty-eight-year old Michelle Zywicki in the Waupaca, Wisconsin public library. She doesn’t earn much working twenty hours a week at Dollar General, and can’t find a full time job. She has no insurance. Zywicki heard she would have to pay a fine for not buying insurance which she cannot afford.

Because her income is low, I told her, she probably would get large subsidies when the mandate took effect. “Why hasn’t anyone told me that?” she shot back angrily. “I’ve tried to read articles and they put me to sleep.” Somehow, dear colleagues, we’ve missed with her—and probably millions more in her shoes.

The president’s equivocation on the public option allowed its large number of supporters to believe it was possible to create an alternative to private insurance, only to have their hopes dashed when it became clear the mighty stakeholders didn’t want it, and so the pols threw it under the bus. Nancy Pelosi herself kept telling reporters that the House bill would have a strong public option, perhaps knowing all along it wouldn’t make the final cut. To the public, Pelosi’s remarks came across as just another politician’s flimflam.

A month ago in Columbia, Missouri, holding one of my periodic town hall meetings, I talked to fifty-six-year-old Charles Paxton, who told me: “When they started it, I was for the law. By the time they got it done, I thought it was not a good idea. There were way too many compromises made to get it passed. You know it’s not going to do what it should.” What news there was of the president’s deal making with insurance companies, doctors, hospitals, and drug companies didn’t sit well with people who thought those days were over.

Republicans have exploited this distrust that is likely to intensify as more people learn about the mandate. “I don’t like the fact people will be forced to buy insurance,” said Hannah Spratt, a University of Missouri sophomore who is not spending her time watching Glenn Beck. Robert Hanna in Lincoln, Nebraska, told me he would never vote for a Democrat ever again, because the president “said he wouldn’t sign a bill that would increase the deficit and include illegal aliens which the bill does.” The GOP message had gotten through.

Shortly after Congress passed the law in March, with the polls showing deep public skepticism, David Axelrod told ABC News: “I think as the American people become familiar with what this program is and what it isn’t, they’re going to be very, very happy with it.”

Seniors with super high drug expenses were supposed to like the $250 rebate, but it is the proverbial drop in the bucket for those whose drug expenses mount in the thousands, and those who remember that the idea of allowing the government to negotiate with drug makers to bring prices down, too, was thrown under the bus. Even though young adults can now get coverage under their parents’ insurance, some are finding that’s not as easy as it sounds.

Others are learning that the law has consequences they weren’t told about. The president said many times people could keep the insurance they had if they liked it. Reform would not affect them. Lifting the lifetime cap, for example, affects only those with catastrophic expenses which most people don’t have. Instead, those whose medical expenses are low are now seeing their premiums rise to cover the additional risk the country’s for-profit insurers must now assume for lifting the cap and other new provisions the law calls for.

In late summer, at a road show cum pep rally in Philadelphia organized by Families USA, the group’s deputy director, Kathleen Stoll, told the crowd, mostly seniors, “there has been a lot of misinformation about Medicare and it’s very frustrating.” But the bait and switch continued. I don’t remember hearing the mandate mentioned, but Stoll did promise “we’ll see insurance more affordable.”

Politico’s Budoff Brown tells us that the Dems are running for cover, reporting that Senate Democrats up for reelection, like California’s Barbara Boxer and Colorado’s Michael Bennet, don’t even mention the law in the health sections of their campaign websites, and don’t take credit for its passage. Obama himself, she reported, does mention the law, “but it’s usually just a few lines wedged between the economy and the financial regulatory overhaul.” How’s that for leadership?

A few years ago, speaking at the annual meeting of the Association of Health Care Journalists, Don Barlett, of the esteemed reporting team of Barlett and Steele, told journalists that we are lying to our readers. I don’t know that we’ve lied as much as ignored parts of the story that mattered to people. My town halls show that there are large segments of the public that still don’t know about the law, and others don’t know what or who to believe.

Campaign Desk repeatedly noted that stories about how reform would affect ordinary people were MIA. “There’s a real danger reform will pass without families knowing what’s in store for them, financially speaking,” I wrote. How can we expect the results to be any different?

As reported by California Healthline, Gov. Arnold Schwarzenegger (R) signed and vetoed several health care-related bills, not to challenge the federal health reform law but rather on the (dubious) grounds that these bills would duplicate its provisions.

So a perfectly reasonable, incremental-approach type bill, AB 2540, by Assembly Member Hector De La Torre (D- South Gate), which would have made it illegal for a health plan to collect a policyholder’s premiums and then rescind coverage after the member becomes ill, was vetoed (so much for the promise of  an end to rescisions).

Similarly, AB 2042, by Assembly member Mike Feuer (D-Los Angeles), which would have prohibited health plans from raising rates more than once each calendar year, was also vetoed (so much for PPACA helping you keep your plan if you like it).

The California governor also vetoed AB 1600, by Assembly member Jim Beall (D-San Jose), which would have required most health insurers to cover the diagnosis and treatment of mental illness, and AB 113, by Assembly member Anthony Portantino (D-La Cañada Flintridge), which would have required most health insurers to cover mammograms (so much for PPACA enhancing preventive health care).

Why would the California governor so blatantly block legislation that would clearly favor ordinary citizens vis-a-vis corporate actors, however important a question, is not the topic of this posting.  Nor is the problem with health care corporations, whose first fiduciary responsibility, like that of any other corporation, is to produce profit for shareholders.

The real question is why leave a basic human need and social right to corporate America in the first place and what is the role of ordinary citizens of democratic nations in deciding upon this and similar issues.

It is high time that these questions be debated in every American household. Their answer will determine what type of country and society we will bestow on our children.

1. Insurers are no longer permitted to rescind coverage for technical mistakes made on patient applications
2. Lifetime monetary limits on insurance coverage will end
3. Adult children will be allowed to remain on their parents’ plan until age 26
4. Insurers will be required to provide certain no-cost preventive services, such as colonoscopies, immunizations and mammograms
5. Consumers will be allowed to appeal claims decisions through an external review process.

These are only a few of the many provisions that take effect as of today, and that as it appears we are supposed to celebrate. But are we?

Not just yet. Let’s look at the “good news” through an alternative, and equally plausible, lens:

Number 1: While insurers may not be permitted to rescind coverage for technical mistakes made on patient applications, they will be able to do so based on other considerations. For instance, based on“intentional misrepresentation”, the number 1 reasons insurers allege to cancel policies.

Number 2: While lifetime monetary limits on insurance coverage will end, these limits apply only to covered services. Uncovered ones will be on patients, as they always have been. And as insurers are permitted to sell policies that cover as little as 60% of covered services (again, only covered services), patients will be extremely vulnerable to financial ruin if they become seriously ill.

Number 3: Yes, your “adult child” will be able to remain on your plan (assuming you have one and you or your “child” pay for the coverage) until age 26. And if you signed up to receive email alerts from Barak’s cheerleaders, Organizing for America, you may have read illustrative stories about the law’s goodness. For instance, you may have read that Kristin, a recent grad living in Scottsdale, Arizona, laments that health reform was not implemented last year, because it would have allowed her to remain on her mom’s plan, something that young folks now are able to do….until they turn 26, of course. But clearly this is only good news compared to the status quo, yet why should this be our standard? If Kristen lived in Canada, or in the UK, or anywhere else in the industrialized world, including Taiwan (and soon in China) she would not be hoping to remain forever young just to have access to her parents’ coverage – at least not for those reasons – because her health care needs would be covered as a matter of right, and for life.

Number 4: Yes, insurers will be required to provide certain no-cost preventive services, but, who do you think is going to foot the bill? You guessed it! All of us in the form of increased premiums — together with the bill for any other provision that affects insurers’ bottom line, such as the provision that insurers spend no more than 20% in administrative overhead.

Indeed, in a less cheerful mood just yesterday, New York Times reporter Robert Pear wrote that  “state insurance regulators told the White House…that health insurance markets in some states would be disrupted unless President Obama gave insurers a temporary dispensation from one major provision of the new health care law” – remarkably, that which requires that insurers spend no more than 20 or 30 cents of every premium dollar on paper shuffling or profit rather than on health care (For the record, the Robert Wood Johnson Foundation estimated that insurers’ expenses on physicians and clinical services amount to a mere 21.2%, so insurers are complaining about having to spend no more than roughly the same amount for “administering” our money).

Just getting a tad ahead of us (and of the law), as California Healthline noted earlier this week, Blue Shield of California has ended its “one-year rate guarantee”. This means that Blue Shield will be able to increase health plan rates throughout the year, instead of waiting for the annual renewal period. As a company spokesperson reported, Blue Shield opted to end the rate “because of forthcoming changes under the federal health reform law”. All which, according to the same source, has left Democrats and Republicans scratching their heads, seeking reasons behind hikes in premium costs (really???).

Ok. If depression has not prevented readers to read this far, let’s examine “reason for celebrating number 5″. As it appears, as of today “consumers” (we’re all consumers now) will be allowed to appeal claims decisions through an external review process. Now, assuming that it is good news that the bad guy will be still around yet now we are allowed to defend ourselves from him, the downside is that it is unclear who will be in charge of those appeals, or more importantly, who will pay for them. Indeed, just days ago, the same California Healthline announced that “state agencies have limited resources to implement reform law”.

Should we be surprised? Not at all. Indeed, the law was not passed to make ordinary Americans happy, although that was certainly the rhetoric. It was passed to satisfy the real constituency of the folks in Washington, a corporate lobby that has hijacked American democracy. In fact it was drafted by a member of that lobby, a WellPoint executive, himself. And they surely have reason to celebrate, now that they’ve been given at least $447 billion in taxpayer money to subsidize the compulsory purchase of their shoddy products.

Can we do something about it? Yes we can. We can, and must, demand a public single payer system that streamlines administration, stops wasting money in paper pushing or inflated prices, puts back medical decisions where they belong — in the hands of providers and patients — and allows us to make badly needed improvements in the health care delivery system – increasing the number of primary providers, emphasizing primary care, and so forth.

We need a new civil rights type movement. We need to demand health care justice for all.

To the Editors of the New York Times

Re: The Recession’s Awful Impact

You correctly state that “the driving force” for the steep rise in uninsurance rates was “a 6.5 million drop in private healthcare coverage as employers laid off workers or eliminated health benefits”. You also correctly state that “the percentage of people covered by employment-based health insurance dropped to 55.8 % in 2009 from 58.5 % the previous year…the lowest level…since 1987”. Moreover, you note that public programs like Medicaid “picked up some of the slack”.

Virtually in the same breath, you praise the Patient Protection and Health Care Act, premised on the same employer-sponsored, for-profit health care, the very same system crumbling in front of our eyes, while completely missing your own point: that taxpayers, once again, are bailing out, and even consolidating the power of, a for-profit system of financing health care that has sorely failed to do its job. Not to mention your complete silence about a valid alternative: a streamlined, improved Medicare for All.

Am I missing something?

Put another way, as the employer-based and private for profit driven health care system crumbles, publicly financed health care comes to the rescue (remember taxpayers’ bailing out the banks? more of the same…).

So how has the Obama Administration reacted to this catastrophe? Well, by implementing a federal health care reform law whose centerpiece is….yes, you guessed it: employer-based and private for profit driven health care!

Let’s think about it: do we really need “more evidence”, or to “wait and see” whether this form of health care financing will finally work? Readers can form their own judgment — there is no paucity of evidence, national or international, in these matters. Below goes some analysis that can help, including a table with a state-by-state analysis.

Number of uninsured skyrockets 4.3 million to record 50.7 million in 2009

Big leap points to urgency of enacting single-payer Medicare for all: national doctors’ group

By Physicians for a National Health Program. September 16, 2010

Contact:
Quentin Young, M.D.
Olveen Carrasquillo, M.D.
Margaret Flowers, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org
Local physicians in almost all 50 states available for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureau showing a dramatic spike of 4.3 million in the number of Americans without health insurance in 2009 – to a record 50.7 million – underscore the urgency of going beyond the Obama administration’s new health law and swiftly implementing a single-payer, improved Medicare-for-all program, according to Physicians for a National Health Program, a 17,000-member physician group.

The Census Bureau reported that 16.7 percent of the population lacked health insurance coverage in 2009, up from 15.4 percent in 2008, when 46.3 million were uninsured.

Lack of health insurance is known to have deadly consequences. Last year researchers at Harvard Medical School showed that 45,000 deaths annually can be linked to lack of coverage.

“Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 51,000 people – that’s about one death every 11 minutes,” said Dr. Quentin Young, national coordinator of PNHP. Young is a Chicago-based retired physician whose private medical practice once counted President Obama among its patients.

Young said that even if the administration’s new health law works as planned, the Congressional Budget Office has projected about 50 million people will be uninsured for the next three years and about 23 million people will remain uninsured in 2019.

“Today’s report suggests those projections are likely too low,” he said.

The jump of 4.3 million uninsured is the largest one-year increase on record and would have been much higher – over 10 million – had there not been a huge expansion of public coverage, primarily Medicaid, to an additional 5.8 million people.

The rise in the number of uninsured was almost entirely due to a sharp decline in the number of people with employer-based coverage by 6.6 million. In 2009, 55.8 percent of the population had such coverage, having declined for the ninth consecutive year from 64.2 percent in 2000.

The record-breaking number of uninsured – exceeding 50 million for the first time since the Census Bureau started keeping records – includes 7.5 million children.

The biggest jumps in the percentage of uninsured were in Alabama, Oklahoma, Ohio, Missouri, Georgia, Delaware, North Carolina and Florida. In terms of absolute numbers, the biggest increases were in California, Florida, Texas, Ohio, Georgia, North Carolina, Illinois, Alabama, Michigan and Pennsylvania. In Massachusetts, 295,000 people remain uninsured despite that state’s 2006 reform. (See link below for historical tables of the uninsured by state.)

“The only way to solve this problem is to insure everyone,” Young said. “And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else’s coverage.”

Dr. Olveen Carrasquillo, a PNHP board member and chief of general internal medicine at the University of Miami’s Miller School of Medicine, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.”

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress and poor medical outcomes for people across our country,” Carrasquillo said.  New research has found that about 14.1 million children and 25 million non-elderly adults were underinsured in 2007, a figure that is likely much higher today.

“The government subsidies under the new health law will not be sufficient to provide quality and affordable coverage to the vast majority of Americans,” he said. “Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform to a single-payer national health insurance program.”

*****
State-by-state data on the uninsured from 2006-2009 can be found here: www.pnhp.org/sites/default/files/docs/2010/Uninsured-by-state-2006-2009.pdf

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

As Medicare celebrated its 45th anniversary July 30, the White House sent its present: a Deficit Commission, composed by some of the very folks who were unable, or unwilling, to see the $8 trillion housing bubble that brought the financial system to a halt. Nope. It’s no joke: these folks are now at the forefront of the campaign to “save” Medicare and the budget.

But, does Medicare need to be saved? Let’s do a little history.

When Medicare was signed into law by President Lyndon Johnson, almost overnight millions of seniors, and later disabled Americans, were able to meet their health care needs, and rates of poverty among them dramatically decreased. Eventually, Medicare added benefits, laid the foundation of studies of health care quality, and provided a model of administrative efficiency still unmatched by for-profit insurers. Today, Medicare meets the health care needs of over 45 million Americans.

To be sure, aging baby boomers will add pressure to Medicare, and the program can be improved: rather than allowing dubious “Advantage” plans, benefits in traditional Medicare could be expanded; gaps, now covered through Medigap policies, a source of profit for insurers yet a financial burden for seniors, could be eliminated; the Kafka-esque Part D could be dumped and Medicare could be allowed to use its huge purchasing power to negotiate prices directly with drug companies, rather than banned from doing so; and doctors’ payments could stop being subject to flawed accounting formulas liable to political manipulation.

So if everything is on the table, how about saving Medicare by expanding it to include everyone living in America? How about replacing the insane patchwork of thousands of plans and paper-pushing designed not to provide access to care, but to undermine it, with a single paying public agent? Over $400 billion could be saved with this move alone, without adding a dime to overall costs. This amount would generously cover all — not “near” all — the uninsured, and improve the coverage of a growing number of Americans who must settle for skimpy policies and unaffordable out-of-pocket costs that drag thousands to bankruptcy annually.

And whatever taxes were needed to finance Medicare-for-All would be generously offset by eliminating increasingly unaffordable out-of-pocket costs and premiums. American families and individuals would see their health care costs precipitously fall and their health care fears vanish. Imagine the change this move would unleash — Americans no longer worried that their dream jobs offer no “health benefits” and businesses finally able to compete internationally with countries guaranteeing public health care.

There is nothing to “wait and see” about the Orwellian Patient Protection and Affordable Care Act signed into law this past March. Close to a century of failed experiments with for-profit insurance for everybody but the most vulnerable among us, who are dumped on taxpayers’ shoulders, should suffice. While millions continue to suffer and die unnecessarily, we already pay for universal health care yet not get it.

Let’s not be misled by propaganda and demand our legislators support a financially sustainable and socially just, publicly funded, privately delivered, universal health care system — a single payer national health program. It’s not too late to do things right. Let’s not take no for an answer so that we can soon sing together “Happy Birthday, Medicare for All!”

Claudia Chaufan received her medical degree in Argentina and her doctorate in sociology at UC Santa Cruz. She is an assistant professor of Sociology and Health Policy at the Institute for Health and Aging at UC San Francisco and vice president of Physicians for a National Health Program — California.

By Claudia Chaufan MD, PhD

In a recent issue in the New England Journal of Medicine, economist Jonathan Gruber praises the Patient Protection and Affordable Health Care Act (PPACA) as a “step in the right direction,” even as he expresses a healthy skepticism about PPACA’s capacity to control escalating health care costs, which he recognizes as “key to the long-term viability of our health care system.” Gruber also argues that there is “shortage of evidence” regarding which approach will meet Americans’ health care needs while controlling costs; therefore there is “no consensus” on what works [1].

Had Gruber looked beyond the U.S. borders, however, he would have found plenty of evidence. For instance, he would have found that U.S. consumption of health care as measured by critical indicators — per capita annual doctor visits, length of stay following heart attacks, or length of stay following normal childbirth – is no greater than the OECD average, and therefore cannot justify the extraordinary level of U.S. spending [2].

He would also have found that U.S. prices for medical care commodities and services are significantly higher than in other nations and constitute a key determinant of U.S. overall spending [3]. And had he looked into why this is the case, Gruber would have found that US high prices are determined by the exceptionally high administrative overhead caused by the system’s fragmented, public-private financing [4] and by the comparatively limited market power of American patients vis-à-vis their counterparts in countries with national health systems where the government negotiates prices with drug and medical device companies [5]. And he might have concluded that PPACA will do predictably little to change all this.

Moreover, the international literature would have shown the author the extraordinary international consensus around nonprofit financing to cover medically necessary services [5].

But what about the dramatic expansion of coverage promised by PPACA? Is this not a step in the right direction? The problem is that insurance coverage, as desirable as it may be, is not health care, but just a means to that end. And the U.S. system is notorious for providing coverage without care. High co-pays and deductibles are significant obstacles to access. Nor does health insurance offer financial security: nearly 78 percent of personal bankruptcies in 2007 that were linked to medical debt involved persons who were insured at the onset of their illness or injury [6]. PPACA, by allowing the sale of premiums for policies that will cover only 60 percent of health expenses [7], will do predictably little to change this state of affairs.

There is, however, an alternative proposal whose financial and policy soundness are based on decades of international experience and evidence. It would improve and expand Medicare to include all residents in the nation or in one state. That alternative may have to wait until PPACA unravels, as it predictably will [8].

President Obama argued that a model of reform as that implemented by PPACA would allow Americans to build on “what works” [9] – a decades-long experience with employer-sponsored for-profit health insurance. Maybe paradoxically, however, PPACA will unravel as employers realize that it is cheaper to pay a fine than pay for increasingly more expensive and inadequate policies, and employees enter the individual health exchanges implemented by the new law and find them so expensive that they “clamor for a nationalized health care system” [10].

References

1. Gruber, J., The Cost Implications of Health Care Reform. N Engl J Med: p. NEJMp1005117.

2. Peterson, C.L. and R. Burton, U.S. Health Care Spending: Comparison with Other OECD Countries. 2007. Order Code RL34175(September 17): p. http://assets.opencrs.com/rpts/RL34175_20070917.pdf (Accessed November 10 2007).

3. Anderson, G.F., et al., It’s The Prices, Stupid: Why The United States Is So Different >From Other Countries. Health Affairs, 2003. 22(3): p. 89-105.

4. Woolhandler, S., T. Campbell, and D.U. Himmelstein, Costs of Health Care Administration in the United States and in Canada. The New England Journal of Medicine, 2003. 349(August 21): p. 768-75.

5. White, J., Competing solutions: American health care proposals and international experience. 1995, Washington D. C: The Brookings Institution.

6. Himmelstein, D., U. , et al., Medical Bankruptcy in the United States, 2007: Results of a National Study. The American Journal of Medicine, 2009. 122(8): p. 741-746.

7. Dorgan, B., The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm, 2010. Democratic Policy Committee.

8. Angell, M., Is the House Health Care Bill Better than Nothing? Physicians for a National Health Program, 2010: p. http://www.pnhp.org/news/2009/november/is_the_house_health_.php (May 17, 2010).

9. The New York Times, Obama’s Health Care Speech to Congress. 2009: p. http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html?_r=1&pagewanted=print (Date accessed September 12, 2009).

10. Helderman, R., Gingrich in Va.: A Republican Congress could defund health care law. 2010: The Washington Post. p. http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html.

Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, public health, comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).

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