Essay on the Financial Crisis by Bill Moyers.

Health Care reform: What Has Been Won and What Has Been Lost So Far

As we near the final version of THE PATIENT PROTECTION AND AFFORDABLE CARE ACT it is time to take full measure of just what has and has not been accomplished. Most importantly what has not been accomplished is a so called public option or early Medicare buy in to pressure the health care insurance industry to lower their premiums. Instead, these protected monopolies, will get roughly 30 million new customers with few restraints on what they can charge for their "product". If that isn't enough to demonstrate the immense lobbying and influence peddling of the giant health care corporations take a look at this article from Huffington Post. Here is an excerpt:

Reuter's [business] noted a big bump Monday morning, after the bill passed the first critical test in the Senate:

"All in all, relative to the last version of health reform issued by the Senate, things have turned out pretty well for the health insurance industry," said Carl McDonald, an analyst at Oppenheimer. "In particular, all versions of a government-run health plan have largely been eliminated."

Thanks to Lieberman's threat, health insurers dodged a major competitor that could have lowered margins, siphoned off customers and impacted profits.

And for those who would argue that the free market is the best way to supply health insurance to the public let me say this. That concept would be a little more palatable if just making a profit was the goal. But these companies are traded on the stock market and any corporation that has stock holders must show not that it is profitable but that it's profits GROW each year. In other words more and more of the money poured into health care through these companies is dedicated to profits every year, not patient care.

In fact denying patient care is their job. So in the long run we have to have a government run single payer system to lower the costs in our health care economy, which is one sixth of our national economy.

This is not to say the insurance companies got off scott free.

• They will no longer be allowed to drop your coverage because you forgot to tell them about a skin tag that was found on you 5 years ago or other such nonsense
• They can no longer impose life time limits which run out when you are fighting an overwhelming disease or disorder
• They can no longer deny you or your children coverage because of a pre-existing condition.
• Insurance companies will be required to spend a preset amount of their premium incomes (80-85%) on providing health care to their beneficiaries.
• Will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost sharing requirements in public and private insurance coverage.

The Senate Finance Committee has posted an extensive list of the provisions of the current bill that will begin as soon as it is signed into law, immediately benefiting consumers. According to Salon very informal discussions will begin between staffers of the pertinent House and Senate committees.

One of the Shames of Being a Texan

The old saw that "everything is bigger in Texas" is sometimes a dumb brag. One area we are the biggest in is the number of uninsured children. One in five children in this state is uninsured. These are not the children of people on the welfare roles as a recent Families USA report shows.

The Families USA report, titled “Left Behind: Texas’s Uninsured Children,” spotlights the following facts about uninsured children in the state:

• 1.4 million children are uninsured in Texas—more than one of out five, or 20.5 percent of Texas’s children. These numbers place Texas first in the nation for the number of uninsured children, and first nationally for the percentage of children in the state without health insurance.

• The number of uninsured children in Texas increased by nearly 33,400 between the three-year period 2003-2005 and the three-year period 2005-2007, and is likely to continue to grow due to the financial crisis.

• Texas’s uninsured children come from working families. In Texas, the vast majority of uninsured children (89.5 percent) come from families where at least one parent works, and nearly three-quarters of uninsured children—or 73.9 percent—live in households where at least one family member works full-time, year-round.

• Nearly two-thirds of Texas’s uninsured children, or 65.7 percent, come from low-income families (families with incomes below twice the poverty level, or $35,200 for a family of three in 2008) who are likely eligible for Medicaid or CHIP.

The majority of Texas republicans seem to think this situation is fine. Our illustrious governor and jaded legislature have turned down federal matching funds for increasing the expansion of CHIP repeatedly. I once discussed this subject with a top aid to one of our local State Senators when the legislature passed new rules that they knew would discourage parents form enrolling their children in the State CHIP program. He basically said that if the parents weren't willing to jump through these new hoops, like re-registering their children every six months, then they didn't deserve the aid. To which I replied "That logic would stand if the parents were getting the health care benefits but it is their helpless children who will do without the health care that their parents don't sign them up for". This type of thinking leads to further refrains such as those who say that these children will get good care in our emergency rooms. That is true in our pediatric hospitals emergency rooms and in those associated with academic medical centers but those are also the most expensive places to obtain any medical care. What could be dealt with in a $75 dollar office visit instead costs a minimum of $1500-$2000. Parents tend to wait until their children are much sicker before they take them to the E.R. and now a new study has shown that this has dire consequences in children.

"According to the Hopkins researchers, the study, to be published Oct. 30 in the Journal of Public Health, is one of the largest ever to look at the impact of insurance on the number of preventable deaths and the potential for saved lives among sick children in the United States....Using more than 23 million hospital records from 37 states between 1988 and 2005, the Hopkins investigators compared the risk of death in children with insurance and in those without. Other factors being equal, researchers found that uninsured children in the study were 60 percent more likely to die in the hospital than those with insurance. When comparing death rates by underlying disease, the uninsured appeared to have increased risk of dying independent regardless of their medical condition, the study found. The findings only capture deaths during hospitalization and do not reflect deaths after discharge from the hospital, nor do they count children who died without ever being hospitalized, the researchers say, which means the real death toll of non-insurance could be even higher.

"If you are a child without insurance, if you're seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance," says lead investigator Fizan Abdullah, M.D., Ph.D., pediatric surgeon at Hopkins Children's.

Thus it follows that if 17,000 children die needless deaths a year because of lack of insurance then Texas has the greatest number of such deaths per capita in the United States. That is a number Texan's should be ashamed of.

The Insurance Companies vs the Public Option

The House That Private Insurance Built

From The Washington Post's Ezra Klein
Following the old adage to never stop digging when you've created such a nice hole for yourself, AHIP is now touting a report (pdf) released by one of its member insurers: the Blue Cross Blue Shield Association. Like AHIP's report, Blue Cross Blue Shield finds that premiums will shoot into the sky with health-care reform. Like AHIP's report, Blue Cross Blue Shield leaves out little things like the insurance exchanges, the excise tax, the delivery system reforms and pretty much everything else in the bill. Like AHIP's report, Blue Cross Blue Shield argues for a stronger individual mandate, which makes policy sense, even if the conclusion is presented dishonestly. Like AHIP's report, Blue Cross Blue Shield does not present any options for funding a stronger mandate.

But what's interesting about the BCBS report is how clearly it shows that insurers have gotten themselves into this mess. Essentially, they've spent so long pricing the sick and the old out of the individual market that they don't really know what to do when they're allowed back in. Consider this paragraph from the analysis:

Insurance reforms alone will substantially increase claims costs in the individual market. The individual market “risk pool” will be less healthy than today and will drive higher insurance premiums. We estimate the average medical claims for the uninsured are 20 percent higher than claims in the current individual market. In addition, certain segments with high medical utilization who are now insured through other arrangements will enter the individual market as a result of guaranteed issue and modified community rating requirements. This includes people enrolled in state high-risk pools, people on COBRA through their former employers’ coverage, and other group conversion policies.

Or this one:

In most parts of the country today, insurers in the individual market are permitted to underwrite and design benefit plans with a variety of price points. This flexibility enables a stable, competitive insurance market. Perhaps most importantly, it offers the greatest affordability to attract younger and healthier members and helps encourage wider enrollment in health insurance.

This is the house they've built: an insurance market where plans are written for the healthy and all legal efforts are made to exclude the sick. That's meant premiums are somewhat lower than they'd otherwise be, but only because the people who most need health-care insurance aren't able to afford it, or in some cases, aren't able to convince anyone to sell it to them. Now that arrangement is ending and they're scared that they can't provide an affordable product to the people who need it. They may be right, but it's evidence of how deeply perverse their business has become, not of what's wrong with health-care reform. When they say that the individual market would be cheaper in the absence of health-care reform, they're saying the individual market would be cheaper if they could continue refusing to sell affordable insurance to people who need health-care coverage.

This isn't an argument against health-care reform. This is proof of its necessity.

Sick For Profit

Health Care That Works

By NICHOLAS D. KRISTOF

Here’s a paradox.

Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector.

Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.

So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.

The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care.

Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effectiveelements in the American medical establishment.

A study by the Rand Corporation concluded that compared with a national sample, Americans treated in veterans hospitals “received consistently better care across the board, including screening, diagnosis, treatment and follow-up.” The difference was particularly large in preventive medicine: veterans were nearly 50 percent more likely to receive recommended care than Americans as a whole.

“If other health care providers followed the V.A.’s lead, it would be a major step toward improving the quality of care across the U.S. health care system,” Rand reported.

As for the other big government-run health care system in the United States, Medicare spends perhaps one-sixth as much on administration as private health insurers, although the comparison is imperfect and controversial.

But the biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick — or, if they start out healthy and then get sick, to find a way to cancel their coverage.

A reader wrote in this week to tell me about a colleague of hers who had health insurance through her company. The woman received a cancer diagnosis a few weeks ago, and she now faces chemotherapy co-payments that she cannot afford. Worse, because she is now unable to work and has to focus on treatment, she has been shifted to short-term disability for 90 days — and after that, she will lose her employer health insurance.

She can keep her insurance if she makes Cobra payments on her own, but she can’t afford this. In her case, her company will voluntarily help her — but I just don’t understand why we may be about to reject health reform and stick with a dysfunctional system that takes away the health coverage of hard-working Americans when they become too sick with cancer to work.

On my blog, foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States.

Let’s hope we won’t miss this chance. A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.

•

HHS: Insurance Companies Encourage Employees to "Revoke Sick People's Health Coverage"

From: The Washington Post/Daily Dose
By David S. Hilzenrath
You might have known that insurers can deny health coverag based on preexisting medical conditions, but here’s something else to worry about:
They can take away the coverage you thought you had when actually need it, the government says. The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.
“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”
“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said. The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims. At least one insurer included such savings in an employee performance evaluation. “Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage," HHS said. The research compiled recently for a House hearing included more detail.
WellPoint and Assurant told the committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and becoming pregnant with twins, the committee staff wrote.
In November 2006, after a Texas resident was found to have a lump in her breast, Wellpoint investigated her medical history and concluded that she had been diagnosed previously with osteoporosis. The insurer rescinded her policy and refused to pay for treatment of the lump, the committee staff wrote. Today’s HHS post, which draws on a variety of studies going back as far as 2001, shows how the Obama administration is trying to give people reasons to support an overhaul of health care even if they are satisfied with their existing coverage. It also reflects a stepped-up focus on health insurers, which are increasingly being cast as bogeymen in the debate.
Under the current system, something as relatively simple as seasonal sneezing can jeopardize your financial security, HHS argues, citing a 2001 study for the Kaiser Family Foundation.
“Even when offering coverage, insurers can exclude whole categories of illnesses related to a preexisting condition. For example, someone with a preexisting condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage,” HHS said.
By Eric Rich | August 11, 2009; 5:50 PM ET

August 24, 2009 Death Panels, Palliative Care, and the Dangers of Modern McCarthyism

From: The Health Care Blog
by: Bob Wachter

It’s time to fight back. The “death panel” nonsense is not a harmless and amusing political canard – it is modern McCarthyism: the shameless, heinous use of lies and distortions to scare and confuse people. The tide will only turn if all of us begin speaking up for the truth.

Read NY Times piece on palliative care, and you get a sense of the power and beauty of the modern movement to provide patients and families with information and support at the end of life. The piece chronicles the decline and ultimate death of Deborah Migliore, a former topless dancer from the Bronx, from metastatic carcinoid, and the efforts of palliative care specialist Sean O’Mahony to support the patient and her husband through her painful final weeks. more

Health Care as a Civil Right

Newsweek 8/15 Jonathan Alter

Obama needs to reframe the debate.

"The United States has two parties now—the Obama Party and the Fox Party. The Obama Party is larger, but it is unfocused and its troops are whiny. The Fox Party, which shows up en masse to harass politicians, is noisy and practiced in the art of simplistic obstruction. As the health-care debate rages, it's the Party of Sort-of-Maybe-Yes versus the Party of Hell No! The Yessers are more lackadaisical because they've forgotten the stakes—they've forgotten that this is the most important civil-rights bill in a generation, though it is rarely framed that way.

The main reason that the bill isn't sold as civil rights is that most Americans don't believe there's a "right" to health care. They see their rights as inalienable, and thus free, which health care isn't. Serious illness is an abstraction (thankfully) for younger Americans. It's something that happens to someone else, and if that someone else is older than 65, we know that Medicare will take care of it. Polls show that the 87 percent of Americans who have health insurance aren't much interested in giving any new rights and entitlements to "them"—the uninsured.

But how about if you or someone you know loses a job and the them becomes "us"? The recession, which is thought to be harming the cause of reform, could be aiding it if the story were told with the proper sense of drama and fright. Since all versions of the pending bill ban discrimination by insurance companies against people with preexisting conditions, that provision isn't controversial. Which means it gets little attention. Which means that the deep moral wrong that passage of this bill would remedy is somehow missing from the debate." more