Tuesday, July 28, 2009

There may be hope yet for a public plan

Tapped: The Group Blog of The American Prospect

July 28, 2009


Like Dana, I'm extremely dismayed by what I see coming out of the Max Baucus committee. But TAP alum Ezra Klein cautions that this isn't the final version of the bill and that there may have to be some concessions for liberals to go along too:

The question is whether Baucus's final product will matter. Rockefeller and the other Democrats on the committee have felt excluded from the negotiations and will want major changes before they can sign onto the final product. Then the Finance bill will have to be reconciled with the more liberal legislation built by the HELP Committee. Then it will have to go to the floor, where it will need the support of people like Russ Feingold and Bernie Sanders and Sherrod Brown just as much as it will need Ben Nelson and Evan Bayh. And then, if it passes those tests, it will have to be reconciled with the House's legislation.
It's frustrating to see this group of conservative senators having so much influence on the health-care bill, not only because the states represented make up a tiny proportion of the population relative to their influence but also because their political interests lie in making reform as ineffective as possible in order to ensure reform doesn't pay political dividends for their opposition. But Klein adds some useful context to think about as Baucus and friends strip almost everything useful out of the finance committee's version of the bill.

-- A. Serwer

Posted at 11:57 AM | Comments (1)


The AP has an anonymously sourced report on the compromise health-reform legislation emerging out of the Senate Finance Committee. It isn't looking good. Some features of the bill:

No government-funded public-insurance option, and no national health-insurance exchange. These features of the House tri-committee and Senate HELP bills are intended to bring down costs by fostering competition on the largest scale possible. Instead, Finance is suggesting regional health co-operatives in which private insurers compete without government intervention. This is likely to lower premiums somewhat, but the smaller size and geographic reach of the co-ops will make them far weaker than a national exchange. And no for-profit company is likely to offer a plan as inexpensive as national public insurance.
An individual mandate to buy health insurance, but no employer mandate. This is regressive. Large employers that refuse to offer health coverage to their workers will have to reimburse the federal government for part of the cost of subsidizing those workers' coverage....
BUT Finance also drastically reduces the number of people eligible for subsides, to only those within 300 percent of poverty ($32,490 for an individual or $66,150 for a four-person family). Senate HELP subsidizes those within 500 percent of poverty and the House bill subsidizes those within 400 percent. Those plans are far more supportive of middle-class families and the self-employed.
Like the House and HELP Committee, Finance would prevent insurers from denying coverage or charging higher premiums because of pre-existing conditions.

House moderates -- like the Blue Dogs -- are likely to grasp on hard to whatever the Finance Committee suggests and run with it, calling it the only politically viable compromise. That's why Finance's proposal is so important. We don't know yet whether Finance, like the House and HELP, will aggressively expand Medicaid coverage. But probably the most worrying aspect of this compromise is how drastically it weakens competition, by asking insurance companies to compete only on a regional basis, and only with one another. This is a plan that leaves employers and insurers in the power seats, while giving consumers far less support than either of the other reform proposals on the table.

--Dana Goldstein

Public Says It's Smarter Than Congress on Health Care

While almost half of Americans believe they have a good understanding of the issues involved in proposals to overhaul the health care system, two-thirds do not believe the same about the lawmakers who will vote on them, according to a Gallup poll conducted July 26.

Would you say that you/members of Congress have a good understanding of the issues involved in the current debate over national health care reform, or not?

Fifty-eight percent of Republicans say they personally have a good understanding of the issues but only 20 percent believe that's true of Congress. Forty-seven percent of Democrats regard themselves as knowledgeable on health care with 34 percent saying they believe Congress understands the issues too. Forty-one percent of independents say they know the issues, but only 26 percent say Congress does.

Saturday, July 25, 2009

Dear Mr. President- No Government-Run Health Care

From Daily Kos:

Dear Mr. President
by Hunter
Sat Jul 25, 2009 at 02:20:04 PM PDT

Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.

Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can't see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they're not in the business of just keeping people alive for free.

Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I'm employed, which is a tough go in the current economy.

Hmm, but that's still a little simplistic. I suppose we should clarify.

I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won't be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company's expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.

And if I didn't know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn't make much sense for my insurance to cover that either.

But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.

Oh -- and the doctors at the insurance company, of course.

They will never actually meet me, or even speak to me on the phone, and in fact I couldn't tell you the name of a single one of them, or what state they were in, or whether or not they've just all been outsourced to a computer program somewhere in Asia at this point -- but they're in charge of determining which treatments might be "effective" for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance -- but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.

And then there's the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving "all requested documentation" somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can't be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough.

So that's getting a bit more complete. I believe my healthcare decisions should be between me, my insurance company plan, my statement of preexisting conditions, the claims adjusters at my insurance company, my insurance company's doctors, my employer, and myself.

And the separate claims review team that will be looking over my treatment.

My health insurer might have flagged me as someone who needs a lot of healthcare, and who is therefore costing the company money. Needing to use the insurance you paid for is naturally a suspicious activity: that means that a special review team will look over my paperwork, seeing if there is any vaguely plausible reason for the company to be rid of me. They will look for loopholes in my application, irregularities in the paperwork my doctor filled out or any other situations which, like magic, mean that all the money I have paid for health insurance premiums was in fact irrelevant, null and void, and they don't have to pay a single cent of claims because I defrauded them by neglecting to remember that I had chicken pox in sixth grade, not fifth, or that what I presumed was a bad cold in 1997 was in fact maybe-possibly-bronchitis, and I can't possibly expect to be covered for any lung-related complaints since then. I suppose I cannot complain too much; after all, this is a crack squadron of employees whose pay is determined by how much they can reduce the healthcare costs incurred by the company. It would be irresponsible for them to not look for such loopholes.

And then there is the board of directors at the insurance company, of course. My personal healthcare is irrelevant, when considered in the abstract; a health insurance company exists to make a profit, and the pay of every executive in the company and every board member is dependent on squeezing out the maximal amount of profits from every dollar.

This is where "experimental" and/or "preventative" treatments come in. New-fangled treatments, things that have only been around for a decade or two, are usually the most expensive. For example, when I complained of chest pains I could have had an CT scan to determine the state of the arteries around my heart, and it would have shown exactly where the problems, if any, lie. This is what the specialist recommended -- but using a CT scan in this way is considered "preventative" treatment, not "diagnostic" treatment, so it is not covered, and I am not allowed to have one. Instead, less accurate tests were used to get a "feel" for what the arteries might look like; these tests are covered. Problem solved; as it turned out, my chest pains were probably a preexisting condition, most likely caused by me having bones. And if it's not, I suppose we'll find out in another ten years or so, when no doubt I am covered by another insurance company and not this one.

These may seem like arbitrary determinations, but they are not. They are based on a rigorous study of how well the treatment works, how much it costs, and how likely it is that the company will have its corporate ass sued off if they do not provide it. This is weighed against the desired profit announcements for the insurance company during that quarter in order to determine how much care must be denied to customers, in aggregate, in order to meet the appropriate financial goals.

Let us not forget the obligations to the stockholders, after all. Of every dollar paid in premiums, currently eighty cents it paid back out for actual medical claims; the rest is administration and profit-taking. Fifteen years ago the number was 95 cents: in other words, the insurance companies themselves have gone from taking five cents of every healthcare dollar to taking twenty cents of every dollar, all since the Clinton presidency.

The stockholders require healthy profits. The executives require personal profits for providing those profits. And since people for some reason aren't getting any healthier, those profits can only come from one place -- reducing what the company pays out when people do become sick.

I recently heard a radio interview with a health insurance company whistleblower; he was describing his trips on the company jet. Gourmet meals were served on china, and the forks were gold plated.

I was pondering this, while looking over the letter from my insurance company informing me that they were switching the coverage of my most expensive monthly medication -- those expensive allergy/asthma shots now count as a "procedure", not as "medicine", and so therefore those vials are not covered by my pharmaceutical plan anymore. It must be very difficult to balance all the tasks of an insurance company CEO. If the corporate jet has inferior place settings, imagine the corporate shame. If a new medication or treatment is no longer considered "experimental", or a treatment classified as actually useful, as opposed to "preventative" nonsense, consider how many millions of dollars the company would have to pay out to give people that treatment. It seems reasonable indeed for the president of my insurance company to have personally pocketed a few hundreds of millions here or there -- I cannot imagine the stress of keeping up with proper utensil etiquette during a time when those you insure are doing you the constant insult of actually getting sick.

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

Study Links Rise in Health Care Costs to Job Losses

Business Week July 23:

In a first-of-its-kind study, the non-profit Rand Corp linked the rapid growth in U.S. health care costs to job losses and lower output. The study, published online by the journal Health Services Research, gives weight to President Barack Obama’s dire warnings about the impact of rising costs if Congress does not enact health care reform.

The Rand researchers examined the economic performance of 38 industries from 1987 through 2005, in an attempt to assess the economic impact of “excess” growth in health care costs on U.S. industries. Excess growth is defined as the increase in health care costs that exceeds the overall growth of the nation’s GDP—a yearly occurrence in the U.S. The team compared changes in employment, economic output and the value added to the GDP product for industries that provide health benefits to most workers to those where few workers have job-based health insurance.

After adjusting for other factors, industries that provide insurance had significantly less employment growth than industries where health benefits were not common. Industries with a larger percentage of workers receiving employer-sponsored health insurance also showed lower growth in their contribution to the GDP.

For example, the study estimated that a 10% increase in excess health care costs would reduce employment by about 0.24 percent in the motor vehicles industry, where 80% of workers are covered by employers. The retail industry, however, where only one third of workers are covered, saw only a 0.13% percent drop in employment. Economy-wide, a 10% increase in excess health care costs growth would result in about 120,800 fewer jobs, $28 billion in lost revenues, and $14 billion in lost GDP value.

This study provides some of the first evidence that the rapid rise in health care costs has negative consequences for several U.S. industries,” said Neeraj Sood, the study’s lead author and a senior economist at RAND. “Industries where more workers receive employer-sponsored health insurance are hit the hardest by rising health care costs.
To rule out the possibility that the economic effects were caused by some other industry-wide factor, the researchers compared U.S. industries with their counterparts in Canada, which has publicly financed universal health care. They found no similar percent change in employment in the corresponding Canadian industries over the 19-year study period.

The rate of growth in U.S. health care costs has outpaced the growth rate in the gross domestic product (GDP) for many years. In 1940, the share of GDP accounted for by health care spending was just 4.5%. By 1990, it had reached 12.2%, and 16% in 2005, when health care spending totaled nearly $2 trillion, or $6,697 per person, far more than any other nation. This year health care spending is on track to equal 18% of GDP.

RAND researchers underscore that their findings do not necessarily mean that rapid growth in health care costs results in large job losses in the overall economy, since losses in industries that cover most of their workers are at least partially offset by gains in those industries that don’t insure. Of course, the workers themselves may not find those jobs equivalent.

The study was partially funded by Bing Center for Health Economics at RAND and the U.S. Department of Health and Human Services.

Wednesday, July 22, 2009

Health care reform makes progress and republicans try to stop it.

The mainstream media is taking their dictation this week from the mega-healthcare corporations that have been spending $1.4 million a DAY to block any change to our national health care system. They are feeding the Republican lie machine with the money they are spending. Who is our lobbyist up there in the capital? The answer is: President Obama.

Did you know that 4 million Americans have lost their health care coverage since 2008? Are you happy with your coverage? Really? How much have your co-pays and deductible risen in the past two years? Do you know how much you are paying in health care expenses a year?

President Obama is committed to enacting health care reform that lowers costs, provides choice- including a public option, and ensures all Americans access to quality, affordable care.

The President supports the creation of a health insurance exchange - a one stop shop, where people can compare and contrast plans and pick the one that’s right for them. A public option in the exchange will increase competition and keep insurance companies honest, expand consumer choices and keep costs low.

To keep preserve what’s best about our system, we have to fix what’s broken and build on what works. No matter how we reform the system, if you like your health care plan, you will be able to keep your health care plan.

This week, GOP leaders in Washington have made it clear that they have no intention to help fix our broken health care system.

In fact, Republican leadership is openly encouraging members to engage in “every activity” to slow down reform.
– South Carolina Senator Jim DeMint (R) called health care President Obama’s “Waterloo” and said it would “break him.”
The GOP is playing politics with our health.
– Instead of siding with America’s families and businesses, they are protecting the mega-healthcare corporations in Washington, DC and doing everything they can to maintain the status quo.
– Instead of fixing our broken health care system, the GOP would rather score political points and prevent millions of Americans access to quality, affordable care.

Insurance Companies
– President Obama does not think the government can or should run health care. But he also doesn’t believe health insurance companies should be able to do whatever they want.
– Health care reform will rein in insurance companies and put an end to unscrupulous health insurance industry practices that bankrupt families and undermine American businesses.
– A public option will increase competition and keep insurance companies honest, expand consumer choices and keep costs low.
– Health care reform will end the worst practices of the insurance industry.

Insurance companies will not be able to:
· Deny people coverage because of a pre-existing condition
· Set yearly or lifetime caps.
· Drop people from their plan when they become ill.

When I hear local people contend that they like the health care system like it is I am amazed. Being a physician I know their tricks and their motives. For health insurance companies it isn't just about making a profit, it is about making ever-increasing profits. That is what their stockholders expect and they don't care one whit about the financial burden that they have to shift on to the backs of their policy holders. Without legitimate reform more and more people will go uninsured and seek care in our publicly funded emergency rooms, driving the cost of care even higher. Premiums will continue to out pace inflation and co-pays will continue to increase at a frightening rate. We can cover everyone in this country. We can also afford it. In fact, without health care reform Medicare and Medicaid alone will bankrupt this nation. We need real change NOW!

Friday, July 10, 2009

What it Costs Doctors to Fight Insurance Companies to Get Paid

What Does It Cost Physician Practices to Interact with Health Insurance Plans?

A national study of nearly 900 U.S. physicians and medical group administrators found that physicians spent on average 142 hours annually interacting with health plans, at an estimated annual cost to physician practices of $31 billion, or $68,274 on average per physician, per year.

The Issue
Administrative costs are high in health care. While those incurred by physician offices are a contributor to overall administrative costs, very little information has been available regarding the costs physician practices incur when they interact with health insurance plans. The authors surveyed a national sample of physicians and medical group administrators to ascertain how much time physician practices spent interacting with health plans on prior-authorization requirements, pharmaceutical formularies, claims, credentialing, contracting, and quality data. The study examines in depth the extent of such interactions, generating both time and dollar value estimates for such administration.

Wednesday, July 8, 2009

Big Questions About Deals Whitehouse is Making with the Big Players in Healthcare

White House, health industry deals raise questions about quid pro quos for private sector.
In a front page story, the New York Times (7/8, A1, Herszenhorn, Stolberg) reports, "The deals, trumpeted loudly by the White House, would each help pay for a sweeping overhaul of the healthcare system." But the promises by health industry groups, drugmakers and hospitals to save the government billions in healthcare costs, hailed as "historic" by the White House, have come with almost no discussion of "what the industry groups will be getting in return for their cooperation, whether or not the promised savings ever materialize." But in spite of the White House's deal making, "some lawmakers said the deals, while seemingly helpful, could raise false expectations by obscuring how much the industry is demanding for its concessions." A rumored deal in the works with doctors "could come at a steep price: a $250 billion fix to a 12-year-old provision in federal law intended to limit the growth of Medicare reimbursements."

Tuesday, July 7, 2009

Lobbyists Descend on Congress to Do the Bidding for Corporations

Washington Post

Familiar Players in Health Bill Lobbying
Firms Are Enlisting Ex-Lawmakers, Aides

The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.

The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post's analysis.

Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

The push has reunited many who worked together in government on health-care reform, but are now employed as advocates for pharmaceutical and insurance companies.

... public interest groups and reform advocates complain that the concentration of former government aides on K Street has distorted the health-care debate, and that it further illustrates the problem posed by the "revolving door" between government and private firms.

"The revolving door offers a short cut to a member of Congress to the highest bidder," said Sheila Krumholz, executive director of the Center for Responsive Politics, which compiled some of the data used in The Post's analysis. "It's a small cost of doing business relative to the profits they can garner."

Monday, July 6, 2009

Senator Ask's Aetna Why Texas Man With Insurance Owes $200,000

New York Times July 2nd.
Late last week Senator Charles Grassley sent a letter to Aetna insurance to ask why a policy they sold a Texas man didn't cover his hospital expenses.

"The man, Lawrence Yurdin, age 64, was included in a front-page article in The New York Times on Tuesday about the many people whose insurance coverage does not protect them from financial ruin in the case of a medical crisis.

Although Mr. Yurdin and the hospital where he received heart treatments say they both understood that the Aetna policy covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the medical care he received. He and his wife, Claire, filed for personal bankruptcy in December.

Senator Grassley, the ranking Republican on the Senate Finance Committee, has also investigated some of the health plans that another insurer, the UnitedHealth Group, sold through AARP, the advocacy group for older people. Those plans, which also had sharp limits on coverage, are no longer being sold.

“I remain concerned about health insurance plans that may appear to offer more coverage than they do and the effect subsequent underinsurance may have on the health care system as a whole,” Mr. Grassley wrote to Aetna’s chief executive, Ronald A. Williams."

In an article in the NYT last Tuesday entitled "Insured, but Bankrupted by Health Crises" Reed Abelson describes the specifics of Mr.Yurdin's case:

"...One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital...
"..“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
"...Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.

Mr. Yurdin learned the hard way.

At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.

He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.

In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there."