Take a look at this great segment from Bill Moyers' Journal, at PBS.
It brings back my favorite observation from T.R. Reid's "Sick Around the World" special: the fact that we in the U.S. don't have a health care system, we have a market. In the same way that sprawl isn't city planning. It's what happens when there isn't city planning.
Showing posts with label The Uninsured. Show all posts
Showing posts with label The Uninsured. Show all posts
13 May 2008
24 January 2008
Uninsurance Hurts the Insured Too
When I saw this editorial in the New York Times, I had mixed feelings. It's on the Harvard study on emergency room delays. (The article in the Boston Globe on that is here.)Their lede:
The NYT edit reads, "Uninsured patients — and those who have no primary care doctor — flock to emergency rooms for routine coverage, clogging the system."
It's important to note that it's not just routine coverage that the uninsured seek care for. It's also life-threatening conditions -- which might have been "routine coverage" had it been treated months earlier, in a physician's office.
What's more, part of the problem is that hospitals, needing to compete in a brutal for-profit environment, are closing emergency rooms, and physicians are declining to be part of care for emergency room patients. From the edit: "The Institute of Medicine, a unit of the National Academy of Sciences, warned two years ago that the nation’s emergency rooms were at a breaking point."
In response -- emergency room closures or near misses:That's just a round-up of today's closure news.
Here in Denver, they're closing city hospitals and relocating to the suburbs. Not a problem, say the PR people -- but if you talk with docs and nurses at Denver Health downtown, they're deeply concerned about what the urban healthcare future holds.
The nation’s failure to provide health insurance for all Americans seems to be harming even many of those who do have good health coverage. That is one very plausible interpretation of a disturbing increase in waiting times at emergency rooms that are often clogged with uninsured patients seeking routine charity care.gives me the sense that one plausible solution is to bar giving medical care to the uninsured via emergency rooms. Although, according to Bush and libertarians, care in emergency rooms is why we already do have "universal health care" in America. The libertarians don't think it's right. It would be a shame if more people came to fear for their own care and instead of doing the right thing, chose to punish instead.
The NYT edit reads, "Uninsured patients — and those who have no primary care doctor — flock to emergency rooms for routine coverage, clogging the system."
It's important to note that it's not just routine coverage that the uninsured seek care for. It's also life-threatening conditions -- which might have been "routine coverage" had it been treated months earlier, in a physician's office.
What's more, part of the problem is that hospitals, needing to compete in a brutal for-profit environment, are closing emergency rooms, and physicians are declining to be part of care for emergency room patients. From the edit: "The Institute of Medicine, a unit of the National Academy of Sciences, warned two years ago that the nation’s emergency rooms were at a breaking point."
In response -- emergency room closures or near misses:That's just a round-up of today's closure news.
Here in Denver, they're closing city hospitals and relocating to the suburbs. Not a problem, say the PR people -- but if you talk with docs and nurses at Denver Health downtown, they're deeply concerned about what the urban healthcare future holds.
Immigrants and health care
What kind of people are we?
At the Un- and Underinsured Congress in December, Celinda Lake presented on the results of her focus groups.
She has found that when you ask Americans about their values in health care -- getting away from ideology and instead towards things like security and affordability -- she has found that in fact most Americans do support universal health care -- or, as she prefers, guaranteed, affordable choice.
However, she warned that she and her staff have in encountered a growing and ugly meanness towards immigrants when it comes to health care.
USA Today has a story today on that intersection between immigration and health care.
Here's a clue from the story: "In a special election to fill the seat of the late Rep. Paul Gillmor, R-Ohio, last month, the National Republican Congressional Committee attacked Democrat Robin Weirauch for backing universal health insurance because it could extend taxpayer-funded health care to illegal immigrants. She lost the race."
Mandates won't help these families.
At the Un- and Underinsured Congress in December, Celinda Lake presented on the results of her focus groups.
She has found that when you ask Americans about their values in health care -- getting away from ideology and instead towards things like security and affordability -- she has found that in fact most Americans do support universal health care -- or, as she prefers, guaranteed, affordable choice.
However, she warned that she and her staff have in encountered a growing and ugly meanness towards immigrants when it comes to health care.
USA Today has a story today on that intersection between immigration and health care.
On a national level, an effort to add legal immigrant children to the State Children's Health Insurance Program was blocked in the Senate last year. Instead, lawmakers added language to ensure that illegal immigrants were excluded.You don't suppose Romney, Tancredo & Co. would exploit this, do you? Pander to people's ugliest sentiments of fear and hatred, rather than call them to their best?
"The phrase 'illegal immigrant' is just radioactive at the moment," says Leighton Ku, a health analyst at the liberal Center on Budget and Policy Priorities. "Efforts to provide additional benefits for the undocumented would be essentially perceived as adding fuel to the fire."
Here's a clue from the story: "In a special election to fill the seat of the late Rep. Paul Gillmor, R-Ohio, last month, the National Republican Congressional Committee attacked Democrat Robin Weirauch for backing universal health insurance because it could extend taxpayer-funded health care to illegal immigrants. She lost the race."
Mandates won't help these families.
The sweeping overhauls of the nation's health care system proposed by Democrats Hillary Rodham Clinton, Barack Obama and John Edwards would not provide coverage for illegal immigrants. "Because the issue is so politically hot, people are staying away from it," says Cecilia Munoz, senior vice president at the National Council of La Raza, the nation's largest Hispanic advocacy group. Only Dennis Kucinich of Ohio, a Democratic long shot, proposes covering them.
That's likely to mean little change in undocumented immigrants' health care status, already the worst in the nation. Even among children, 53% are uninsured, according to Jeffrey Passel of the Pew Hispanic Center. That compares with 9% of U.S. citizens' children.
In North Carolina's rural Duplin County, more than one in four people are uninsured. The area's job growth is in low-wage agribusiness — "plucking chickens and gutting hogs," says Greg Bounds, chief executive officer of Goshen Medical Center, the area's largest group of community health centers. Businesses need the influx of illegal immigrants to take hard-to-fill jobs, but hospitals lose money when the workers need emergency care.
Until recently, most illegal immigrants here had one health care strategy. "They just weren't getting care before," Bounds says. "They were just suffering and dying."
14 January 2008
Donna Smith is 47,000,001
Donna Smith blogged the other day at Michael Moore's Sicko blog that she's joined the ranks of the uninsured.
She emails today that it's not 18,300 deaths a year (estimate from the Institute of Medicine) any more. That's 50 per day, and we've all been using that figure for a long time. The number is now estimated at 22,000/year -- 137,000 from 2000-2006. Donna writes:
And so what are the rest of us left feeling? There's guilt in with the anger. I won't name the people in my family who are uninsured, even after Paul's death. But I will say that they're not gaming the system any more than Donna is. If they could afford coverage they would have it.
How many families have to have uninsured members, and how many people have to die -- from underinsurance or from being uninsured -- before enough of us say enough.
I think we've reached the tipping point.
She emails today that it's not 18,300 deaths a year (estimate from the Institute of Medicine) any more. That's 50 per day, and we've all been using that figure for a long time. The number is now estimated at 22,000/year -- 137,000 from 2000-2006. Donna writes:
I wrote the blog about joining the ranks of the uninsured. In reviewing the Jan 2008 Urban Institute report raising the estimates of the dead due to a lack of insurance, I plan to write yet another blog hoping I will not become yet another statistic in 2008: 22,001. I'd have to write that piece in advance of being added to that list --Anything for the cause, Donna, but that's a bridge too far...
And so what are the rest of us left feeling? There's guilt in with the anger. I won't name the people in my family who are uninsured, even after Paul's death. But I will say that they're not gaming the system any more than Donna is. If they could afford coverage they would have it.
How many families have to have uninsured members, and how many people have to die -- from underinsurance or from being uninsured -- before enough of us say enough.
I think we've reached the tipping point.
09 January 2008
Pesticides for breakfast, HSAs on the side
In its wisdom, The Denver Post chose free-market crank Jackie Avner to be one of their Colorado Voices this go round. Inconceivable. Did the editors look back on their poor work in balancing the massive shift from the center to the right that took place in their pages in the 1990s and continues today, and decide that this time around they'd do things differently?
Back in the '90s, when the right was in full cry against the supposed liberal bias of the media, editors and producers obligingly began giving right-wing views far more print than progressives were allotted.
Now it's liberal voices noting a real imbalance — but the press has learned their lesson, and aren't to be moved. And thus the current crop of Colorado Voices?
In her most famous column, Avner wrote, "I don't like to buy organic food products, and avoid them at all cost. It is a principled decision reached through careful consideration of effects of organic production practices on animal welfare and the environment. I buy regular food, rather than organic, for the benefit of my family."
I doubt even John Caldera takes such a principled stand.
Today Avner takes on the health care crisis with equal astuteness. In her considered opinion, it's regular folks' own fault that medical expenses are too high.
This is a shopworn talking point from the right; one that has elements of truth but is far from the real reason that costs are out of control. That's especially true since Avner doesn't include the fact that people do share some personal responsibility for falling for the fear-mongering myths about single-payer spun out by the health insurance industry. It doesn't take much effort to discover a virtual mountain of data showing that guaranteed, universal health care, with either a single payer or very nearly single-payer financing, gives quality health care at a far lower cost.
In any case, here are some of the problems with Avner's article.
"Some Americans choose to buy things other than health insurance. Nearly 40 percent of the uninsured reside in households with earnings greater than $50,000. Their health care costs are spread among everyone else."
The U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation found in 2005 that 27% of the uninsured have incomes above 300% of poverty, with one-in-ten (11%) uninsured above 500% FPL. Federal poverty level for 2007 is $10,210 for an individual; $13,690 for a two-person household; and $20,650 for a four-person household. Here in Colorado, the Colorado Health Institute reported that for 2003-2005, about 42 percent of Coloradans with family incomes under 100 percent of the poverty level (then $19,350 for a family of four) were uninsured, compared with 6 percent of those with incomes above 400 percent of the poverty level ($77,400).
It looks as though Jackie may have been misled about that 40 percent figure. Her source material might be biased. And before we get too exercised about how those folks making four times the poverty level should have health insurance, consider that the average health insurance policy for a family is about $12,000. For a family with special needs — Nathan Wilkes' family, for instance — $12,000 a year is in your dreams. At what point is insurance unaffordable? When it's $1,000 a month for an individual? When it's a quarter of your income? When the choice is between insurance and housing? Not to mention the ugly choice between insurance and the American dream of starting your own small business.
As for the cost shifting, it's hard to say how much of it is justified and how much comes from the uninsured. Medicare and Medicaid also are a cause here, as are a myriad of other elements. What is Avner's solution? It's hard to believe she'd be in favor of forced mandates to buy health insurance, so what does she propose? Denying care? (Which is, of course, already done to some extent. Ask my brother's widow.)
Most Americans choose to overeat. According to the World Health Organization, 74 percent of U.S. adults are overweight or obese. Obesity contributes to expensive, chronic conditions such as diabetes, hypertension and heart disease.
Take a look at the bugs. What is the correlation? Since every country on that chart except the U.S. has guaranteed health care, one might almost conclude that knowing that your health care was secure caused people to eat less.
Americans over-consume pharmaceutical drugs, tests and procedures from the buffet of health care options, including those our doctors think will be marginally effective. Our reasoning is, "If it doesn't cost me anything extra, why not try it?"
That excess consumption of marginally effective pharmaceuticals couldn't have anything to do with the barrage of advertising with which we're deluged, could it?
Actually, this is a problem that all health care systems grapple with. Europeans do indeed consume more health care than do Americans. They see their doctors more often, have more procedures, etc. And yet per capita, the cost is about half as much. Dang.
Avner goes on to beat this dead horse for several more paragraphs. It's odd — the right usually likes to tell people that it's everyone else's fault but their own, but not here. Then again, most people don't consume too much health care. About 70 percent of health care dollars go to just 10 percent of the population. They are the sick and injured ones, after all. A certain number of people though will want to believe that the answer is as simple as keeping (other) people from overconsuming. They've all heard of the lonely old lady who goes to her doctor for hangnails.
This argument sits uneasily with the one that says that universal health care isn't a good idea because it might limit our consumption of health care — rationing, you know.
Ironically, the British are now experimenting with a program that would encourage people to do more self-care — keeping track of their own blood pressure, etc. — and the right has decried it as proof that "Britain's 60-year-old National Health Service can no longer support the weight of its clamoring clientele."
Eh. Who knows whether it's a good idea to have people monitor their heart activity, blood pressure and lung capacity using equipment that has been placed in the home — with them telephoning or emailing in the results. Obviously there's room there for bad judgment. Not all patients will be capable of doing it. But all in all I think I'd rather take my own blood pressure at home than have to trek into a clinic twice a week to do it. In fact, that sounds like just the kind of thing computers and education are supposed to empower us to do.
Avner thinks the solution lies in that great innovation health savings accounts. Because she now has an HSA, she now shops for the best deal she can find for dental and eye glasses (odd examples, since an awful lot of insurance policies don't cover those items anyway) and she uses generic drugs. "My behavior is entirely different, and entirely more responsible as a result of a simple incentive from the government," she writes, seeming to agree that in fact government can be a force for good. Through tax policy.
Uwe Reinhardt has an essay in Health Affairs blog on HSAs. Reinhardt notes that HSAs do work as advertised by the right when the purchasers are in a high tax bracket and have a low deductible. "...[T]he tax-preference accorded to HSAs effectively makes health care more expensive for low-income persons than for high-income persons," he writes.
That's already the case, of course, but Reinhardt's analysis shows that HSAs are a solution only for higher income families like Avner's — whose husband is a physician.
Now about that aversion to organic food. Blood samples of children, ages 2 to 4, show concentrations of pesticide residues to be six times as high for kids who eat conventionally farmed fruits and veggies — the kind Jackie likes — compared to kids eating organic.
But maybe organophosphorus pesticides are only a cancer risk for the reality-based community. And sunspots are responsible for the itty bitty weather changes we may or may not be seeing. And there were caches of WMDs in Baghdad.
Back in the '90s, when the right was in full cry against the supposed liberal bias of the media, editors and producers obligingly began giving right-wing views far more print than progressives were allotted.
Now it's liberal voices noting a real imbalance — but the press has learned their lesson, and aren't to be moved. And thus the current crop of Colorado Voices?
In her most famous column, Avner wrote, "I don't like to buy organic food products, and avoid them at all cost. It is a principled decision reached through careful consideration of effects of organic production practices on animal welfare and the environment. I buy regular food, rather than organic, for the benefit of my family."
I doubt even John Caldera takes such a principled stand.
Today Avner takes on the health care crisis with equal astuteness. In her considered opinion, it's regular folks' own fault that medical expenses are too high.
This is a shopworn talking point from the right; one that has elements of truth but is far from the real reason that costs are out of control. That's especially true since Avner doesn't include the fact that people do share some personal responsibility for falling for the fear-mongering myths about single-payer spun out by the health insurance industry. It doesn't take much effort to discover a virtual mountain of data showing that guaranteed, universal health care, with either a single payer or very nearly single-payer financing, gives quality health care at a far lower cost.
In any case, here are some of the problems with Avner's article.
"Some Americans choose to buy things other than health insurance. Nearly 40 percent of the uninsured reside in households with earnings greater than $50,000. Their health care costs are spread among everyone else."
The U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation found in 2005 that 27% of the uninsured have incomes above 300% of poverty, with one-in-ten (11%) uninsured above 500% FPL. Federal poverty level for 2007 is $10,210 for an individual; $13,690 for a two-person household; and $20,650 for a four-person household. Here in Colorado, the Colorado Health Institute reported that for 2003-2005, about 42 percent of Coloradans with family incomes under 100 percent of the poverty level (then $19,350 for a family of four) were uninsured, compared with 6 percent of those with incomes above 400 percent of the poverty level ($77,400).
It looks as though Jackie may have been misled about that 40 percent figure. Her source material might be biased. And before we get too exercised about how those folks making four times the poverty level should have health insurance, consider that the average health insurance policy for a family is about $12,000. For a family with special needs — Nathan Wilkes' family, for instance — $12,000 a year is in your dreams. At what point is insurance unaffordable? When it's $1,000 a month for an individual? When it's a quarter of your income? When the choice is between insurance and housing? Not to mention the ugly choice between insurance and the American dream of starting your own small business.
As for the cost shifting, it's hard to say how much of it is justified and how much comes from the uninsured. Medicare and Medicaid also are a cause here, as are a myriad of other elements. What is Avner's solution? It's hard to believe she'd be in favor of forced mandates to buy health insurance, so what does she propose? Denying care? (Which is, of course, already done to some extent. Ask my brother's widow.)
Most Americans choose to overeat. According to the World Health Organization, 74 percent of U.S. adults are overweight or obese. Obesity contributes to expensive, chronic conditions such as diabetes, hypertension and heart disease.
Take a look at the bugs. What is the correlation? Since every country on that chart except the U.S. has guaranteed health care, one might almost conclude that knowing that your health care was secure caused people to eat less. Americans over-consume pharmaceutical drugs, tests and procedures from the buffet of health care options, including those our doctors think will be marginally effective. Our reasoning is, "If it doesn't cost me anything extra, why not try it?"
That excess consumption of marginally effective pharmaceuticals couldn't have anything to do with the barrage of advertising with which we're deluged, could it?
Actually, this is a problem that all health care systems grapple with. Europeans do indeed consume more health care than do Americans. They see their doctors more often, have more procedures, etc. And yet per capita, the cost is about half as much. Dang.
Avner goes on to beat this dead horse for several more paragraphs. It's odd — the right usually likes to tell people that it's everyone else's fault but their own, but not here. Then again, most people don't consume too much health care. About 70 percent of health care dollars go to just 10 percent of the population. They are the sick and injured ones, after all. A certain number of people though will want to believe that the answer is as simple as keeping (other) people from overconsuming. They've all heard of the lonely old lady who goes to her doctor for hangnails.
This argument sits uneasily with the one that says that universal health care isn't a good idea because it might limit our consumption of health care — rationing, you know.
Ironically, the British are now experimenting with a program that would encourage people to do more self-care — keeping track of their own blood pressure, etc. — and the right has decried it as proof that "Britain's 60-year-old National Health Service can no longer support the weight of its clamoring clientele."
Eh. Who knows whether it's a good idea to have people monitor their heart activity, blood pressure and lung capacity using equipment that has been placed in the home — with them telephoning or emailing in the results. Obviously there's room there for bad judgment. Not all patients will be capable of doing it. But all in all I think I'd rather take my own blood pressure at home than have to trek into a clinic twice a week to do it. In fact, that sounds like just the kind of thing computers and education are supposed to empower us to do.
Avner thinks the solution lies in that great innovation health savings accounts. Because she now has an HSA, she now shops for the best deal she can find for dental and eye glasses (odd examples, since an awful lot of insurance policies don't cover those items anyway) and she uses generic drugs. "My behavior is entirely different, and entirely more responsible as a result of a simple incentive from the government," she writes, seeming to agree that in fact government can be a force for good. Through tax policy.
Uwe Reinhardt has an essay in Health Affairs blog on HSAs. Reinhardt notes that HSAs do work as advertised by the right when the purchasers are in a high tax bracket and have a low deductible. "...[T]he tax-preference accorded to HSAs effectively makes health care more expensive for low-income persons than for high-income persons," he writes.
That's already the case, of course, but Reinhardt's analysis shows that HSAs are a solution only for higher income families like Avner's — whose husband is a physician.
Now about that aversion to organic food. Blood samples of children, ages 2 to 4, show concentrations of pesticide residues to be six times as high for kids who eat conventionally farmed fruits and veggies — the kind Jackie likes — compared to kids eating organic.
But maybe organophosphorus pesticides are only a cancer risk for the reality-based community. And sunspots are responsible for the itty bitty weather changes we may or may not be seeing. And there were caches of WMDs in Baghdad.
08 January 2008
101,000 excess deaths in U.S.
A recent study published in Health Affairs show that there aren't just 18,000 deaths a year because of our idiotic system, there are actually 101,000 excess deaths annually. France, Japan and Australia rated best and the United States worst. The study focused on preventable deaths due to treatable conditions in 19 industrialized nations. The U.S. health care system's shortcomings resulted in 101,000 more deaths than if we'd had a system based on care rather than profit.
Good comment on this at Cronespeaks:
Bravo, Ootpoot!
Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did.Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal. The United States comes in last.
They called such deaths an important way to gauge the performance of a country's health care system.
Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study.
"I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview.
Good comment on this at Cronespeaks:
As a Canadian, I do not want to see the USA get universal health care or free universal education. Much of Canada’s increasing economic advantage comes from the malaise and stupidity of directly competing demographic areas in the USA; and we are winning because of our healthcare and educational advantages.It could be that Stuart Butler, Canada's anti-Michael Moore "brilliant" filmmaker, Stuart Browning might sign her on to help him... You think he'd go for that?
Recently, Toyota chose Ontario Canada over Alabama as a site for their largest manufacturing site. Why?
Toyota cited a much more highly educated workforce and the savings in healthcare costs as the deciding factors in choosing Canada. Please keep your present system in the USA — it’s “Merkan, so it’s gotta be the ‘best’!
Bravo, Ootpoot!
31 August 2007
Cancer Society focuses ads on uninsured
The New York Times reports today that the Cancer Society's $15 million ad budget for the coming year will focus on the uninsured. The article notes, "The campaign was born of the group’s frustration that cancer rates are not dropping as rapidly as hoped, and of recent research linking a lack of insurance to delays in detecting malignancies."
Other disease-fighting charities have applauded the move.
Before we get too misty-eyed about what a good sign this is, let's point out that the Cancer Society's theme is the "consequences of inadequate health coverage." That promotes buying more health insurance, putting more money into bonus checks to Aetna executives at the expense of struggling families. j
Then again, before we get to cynical, the Cancer Society risks its funding with these ads from foundations associated with the obscenely profitable medical-industrial industry. That money is crucial to the existence of the society. They have to walk a fine line here.
Celinda Lake's research shows that fear entrenches the status quo. Hopefully these ads will inspire anger and not fear. Which will it be?
Other disease-fighting charities have applauded the move.
Before we get too misty-eyed about what a good sign this is, let's point out that the Cancer Society's theme is the "consequences of inadequate health coverage." That promotes buying more health insurance, putting more money into bonus checks to Aetna executives at the expense of struggling families. j
Then again, before we get to cynical, the Cancer Society risks its funding with these ads from foundations associated with the obscenely profitable medical-industrial industry. That money is crucial to the existence of the society. They have to walk a fine line here.
Celinda Lake's research shows that fear entrenches the status quo. Hopefully these ads will inspire anger and not fear. Which will it be?
One features images of uninsured cancer patients, appearing hollow and fearful. “This is what a health care crisis looks like to the American Cancer Society,” the narrator begins. “We’re making progress, but it’s not enough if people don’t have access to the care that could save their lives.”The NYT piece also refers to a 2003 study estimating that one of every 10 cancer patients was uninsured and other surveys that "have found that one of every four families afflicted by cancer, which is projected to kill 560,000 Americans this year, is effectively impoverished by the fight, including one of every five with insurance."
The other commercial depicts a young mother whose family has gone into debt because her insurance did not fully cover her cancer treatment. “Is the choice between caring for yourself and caring for your family really a choice?” the narrator asks.
30 May 2007
Obama plays it safe
Obama came out with his healthcare plan yesterday — and it wasn't single-payer.
Counterpunch's Corporate Crime Reporter explained why back in February:
Back to the present, Edwards estimates his plan would cost $90 billion to $120 billion; Obama figures $50-$65 billion for his. (A nice chunk of protection cash either way for the various powerful insurance families. The Gambinos themselves couldn't have done better.) Obama's plan, like Edwards, includes unspecified employer contributions, cost-saving measures, and specifically coverage for all children. Edwards' plan mandates that individuals have insurance; Obama's doesn't.
Speaking of the families, in particular the bosses, this wouldn't be a complete win. Both Edwards and Obama would pay the insurance families in part by getting rid of some of Bush's tax cuts for the wealthy.
As for the other candidates, Senator Christopher Dodd, who sold out to the insurance industry back in the 1990s, and Governor Bill Richardson also like mandates. Alaska Mike Gravel likes vouchers — which could be single-payer. Sen. Joseph Biden is the most timid. He'd insure children — an increasing number of them orphans and paupers as parents have a harder and harder time covering themselves. Sen. Hillary Clinton also talks a lot about children. She hasn't shown us her cards yet, but she has promised to reduce the power of insurance companies and to computerize medical records — a good start.
Rep. Dennis Kucinich is of course unabashedly for single-payer. He'd pay for it with income and payroll taxes, and a tax on stock and bond transactions.
Kevin Drum doesn't think much of Obama's plan. "Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal. This is not necessarily a bad thing: the time he's spent in the trenches doing community organizing and then as a state legislator seems to have taught him that there are no easy answers; that political coalitions are hard to build; and that real progress often requires a slow but steady approach. He may even be right about that. Certainly I'm no revolutionary myself. Still, sometimes audacity requires audacity. Hope isn't always enough."
Ezra Klein explains the plan, which includes a new regulatory agency called the National health Insurance Exchange — which would both regulate the insurance industry and administer a new public insurance program:
MSNBC rounds up of mainstream coverage of Obama's announcement. Here is the quote there from the LAT: "Like the other top Democratic presidential contenders, he rejects the left's growing support for a government-run, single-payer healthcare system. Instead, he proposes to reinforce the existing system, under which the vast majority of Americans receive coverage either through their employers or through government programs such as Medicare and Medicaid."
Counterpunch's Corporate Crime Reporter explained why back in February:
The majority of the American people want a single-payer health care system Medicare for all.Take a look at that entire Counterpunch article, which interviews Dr. Steffie Woolhandler of PNHP.
The majority of doctors want it. A good chunk of hospital CEOs want it. But what they want doesn't appear to matter.
Why?
Because a single-payer health care plan would mean the death of the private health insurance industry and reduced profits for the pharmaceutical industry.
Presidential candidates John Edwards, Barack Obama, Hillary Clinton, and Mitt Romney and California Governor Arnold Schwarzenegger talk a lot about universal health care.
But not one of them advocates for single-payer because single-payer too directly confronts the big corporate interests profiting off the miserable health care system we are currently saddled with.
Back to the present, Edwards estimates his plan would cost $90 billion to $120 billion; Obama figures $50-$65 billion for his. (A nice chunk of protection cash either way for the various powerful insurance families. The Gambinos themselves couldn't have done better.) Obama's plan, like Edwards, includes unspecified employer contributions, cost-saving measures, and specifically coverage for all children. Edwards' plan mandates that individuals have insurance; Obama's doesn't.
Speaking of the families, in particular the bosses, this wouldn't be a complete win. Both Edwards and Obama would pay the insurance families in part by getting rid of some of Bush's tax cuts for the wealthy.
As for the other candidates, Senator Christopher Dodd, who sold out to the insurance industry back in the 1990s, and Governor Bill Richardson also like mandates. Alaska Mike Gravel likes vouchers — which could be single-payer. Sen. Joseph Biden is the most timid. He'd insure children — an increasing number of them orphans and paupers as parents have a harder and harder time covering themselves. Sen. Hillary Clinton also talks a lot about children. She hasn't shown us her cards yet, but she has promised to reduce the power of insurance companies and to computerize medical records — a good start.
Rep. Dennis Kucinich is of course unabashedly for single-payer. He'd pay for it with income and payroll taxes, and a tax on stock and bond transactions.
Kevin Drum doesn't think much of Obama's plan. "Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal. This is not necessarily a bad thing: the time he's spent in the trenches doing community organizing and then as a state legislator seems to have taught him that there are no easy answers; that political coalitions are hard to build; and that real progress often requires a slow but steady approach. He may even be right about that. Certainly I'm no revolutionary myself. Still, sometimes audacity requires audacity. Hope isn't always enough."
Ezra Klein explains the plan, which includes a new regulatory agency called the National health Insurance Exchange — which would both regulate the insurance industry and administer a new public insurance program:
...That's a big deal — one of the real tests of seriousness for the new plans is whether they create a public insurance program, and Obama's does. Unlike Edwards' and Jacob Hacker's plans, he doesn't use Medicare as the basis for the program, but instead creates an entirely new public insurer.RJ Eskow predictably puts down criticism of incremental plans that funnel tax money to the private insurance market:
Here's the catch: The Obama plan does not set the public and private plans in competition with each other, as the Edwards plan does. Rather, the best way to think of it is as a two-track plan. The first track extends the new public program to the self-employed, small businesses, and the uninsured. In other words, the public plan is open to those who are currently disadvantaged in the insurance market — it is not a new insurance market unto itself. That said, if it proves popular and effective, it would be trivial to expand it in the future, letting all businesses, or all individuals, buy in.
The second track is a restructured insurance market. Participating insurers ... will have to offer minimum benefits, spend a certain portion of their budget on patient care (rather than profits and advertising), be barred from discriminating on health history, and be forced to justify large premium increases. Employers will have to either pay into this market, or pay into the national plan.
...The Obama campaign's decision to omit a mandate is a puzzling one, both from a policy perspective -- you want the largest possible risk pool -- and a political one. His plan, unlike others, is not truly universal, it's simply possibly universal.
Rose Ann De Moro, for example, has done terrific work as leader of the California Nurses Association. But she drips with contempt for anything less than immediate single-payer reform. Barack Obama is "rearranging deck chairs on the Titanic," she writes. Really? Someone who receives coverage for the first time under the Obama plan, or who gets better care, might feel more like they'd been rescued from a shipwreck. The John Edwards plan, which forces private insurers to compete with a public program, would lead inevitably to single payer unless private insurers could offer something else that some part of the public might want. Nevertheless, to Ms. De Moro the Edwards plan is a "soggy mix and match."Eskow claims he'd switch our system in a heartbeat for Britain's — but, since that won't work, he's for the incremental steps. Which is a bit of a self-fulfilling prophesy...
"Edwards does deserve some credit for proposing that at least one plan in each health market be a public program based on Medicare," she writes. "But, if a public program, as he implies, is more likely to assure affordable alternatives to the private insurance model, why get off in Chicago when your plane is going to New York?" Here's why: If the plane doesn't have enough fuel to get to New York, you stop off in Chicago. If some passengers want to get off there, that's fine too. But Ms. De Moro, like other single-payer absolutists, gives this aspect of the Edwards plan only a passing glance before dismissing him by saying he "should go back to being a populist."
MSNBC rounds up of mainstream coverage of Obama's announcement. Here is the quote there from the LAT: "Like the other top Democratic presidential contenders, he rejects the left's growing support for a government-run, single-payer healthcare system. Instead, he proposes to reinforce the existing system, under which the vast majority of Americans receive coverage either through their employers or through government programs such as Medicare and Medicaid."
24 May 2007
Rationing care
I heard a story yesterday that renews my belief that so many Americans have been affected by the slow-motion disaster of our current healthcare system that we will be able to change it.
I was at the Denver Conference on Homelessness, handing out brochures and talking with people about single-payer financed healthcare. I was with a sharp, intelligent and lively Health Care for All Colorado volunteer, Ruth Gilbert. It was Ruth's 84th birthday.
We heard about homelessness from the people with whom we shared a lunch table, and we told them about the need for universal healthcare. As if they didn't know.
One of the women at the table had lived in Britain for a time. She spoke with awe and respect for their system.
Another women at the table then spoke up. She said her 30-year-old daughter had been diagnosed with Hodgkins Disease — cancer that starts in the lymphatic tissue. The ill daughter missed a lot of work during the course of her treatment and lost her job.
When the daughter lost her job, she lost her insurance. And here her mother stumbled a bit in the telling — her family had been under a lot of stress with the illness, and they hadn't managed to do what, perhaps, might have been done so that the ill woman's coverage could have continued. Perhaps.
So should that be a death sentence? Add into your consideration the fact that the daughter has three children. She completed her chemo, but not her radiation.
We are the wealthiest country in the world. Should this woman's children be motherless because their mother cannot pay for cancer treatment? Should scrambling for a way to pay for treatment, should the humiliation of losing her job and not being able to pay, should potential bankruptcy — hell, potential homelessness — be a part of her reality now? How might that stress be affecting her chances for survival?
How is depending on charity in a situation like this, rather than according this woman and her family the dignity of healthcare justice, a conservative or American value?
I was at the Denver Conference on Homelessness, handing out brochures and talking with people about single-payer financed healthcare. I was with a sharp, intelligent and lively Health Care for All Colorado volunteer, Ruth Gilbert. It was Ruth's 84th birthday.
We heard about homelessness from the people with whom we shared a lunch table, and we told them about the need for universal healthcare. As if they didn't know.
One of the women at the table had lived in Britain for a time. She spoke with awe and respect for their system.
Another women at the table then spoke up. She said her 30-year-old daughter had been diagnosed with Hodgkins Disease — cancer that starts in the lymphatic tissue. The ill daughter missed a lot of work during the course of her treatment and lost her job.
When the daughter lost her job, she lost her insurance. And here her mother stumbled a bit in the telling — her family had been under a lot of stress with the illness, and they hadn't managed to do what, perhaps, might have been done so that the ill woman's coverage could have continued. Perhaps.
So should that be a death sentence? Add into your consideration the fact that the daughter has three children. She completed her chemo, but not her radiation.
We are the wealthiest country in the world. Should this woman's children be motherless because their mother cannot pay for cancer treatment? Should scrambling for a way to pay for treatment, should the humiliation of losing her job and not being able to pay, should potential bankruptcy — hell, potential homelessness — be a part of her reality now? How might that stress be affecting her chances for survival?
How is depending on charity in a situation like this, rather than according this woman and her family the dignity of healthcare justice, a conservative or American value?
13 May 2007
Don McCanne's quote of the day
Don McCanne, former president of Physicians for a National Health Program, has a list he calls the healthcare quote of the day.
A couple people forwarded this one to me. In it, Don has cited a new CNN poll (pdf) with this question:
30. Do you think the government should provide a national health
insurance program for all Americans, even if this would require
higher taxes?
64% - Yes
35% - No
2% - No opinion
Don doesn't just leave his readers with one item to think about — he also quotes Catholic Healthcare West's study on Health Security in America (May 9, 2007, also a pdf), in which respondents said:
The time has come for universal healthcare in America. (72%)
We need universal healthcare in America, even if it means
increasing taxes. (63%)
Don writes, "If these poll numbers were cast at the ballot box, this
would constitute a clear mandate from the American public. So why do
we keep hearing that national health insurance is not politically
feasible?"
The answer may be because those poll numbers have been the same for decades. They fall pretty easily, with just a few million dollars worth of well-planned propaganda. Americans are easily scared. Politicians know it.
A couple people forwarded this one to me. In it, Don has cited a new CNN poll (pdf) with this question:
30. Do you think the government should provide a national health
insurance program for all Americans, even if this would require
higher taxes?
64% - Yes
35% - No
2% - No opinion
Don doesn't just leave his readers with one item to think about — he also quotes Catholic Healthcare West's study on Health Security in America (May 9, 2007, also a pdf), in which respondents said:
The time has come for universal healthcare in America. (72%)
We need universal healthcare in America, even if it means
increasing taxes. (63%)
Don writes, "If these poll numbers were cast at the ballot box, this
would constitute a clear mandate from the American public. So why do
we keep hearing that national health insurance is not politically
feasible?"
The answer may be because those poll numbers have been the same for decades. They fall pretty easily, with just a few million dollars worth of well-planned propaganda. Americans are easily scared. Politicians know it.
11 May 2007
208 Commission picks 11 plans
On Monday, The Colorado Blue Ribbon Commission for Health Care Reform culled their 28 proposals down to ten — wait... make that eleven.
1) Better Health Care for CO - SEIU
2) Solutions for a Healthy Colorado - CO State Association of Health Underwriters
3) A Phased Approach to Achieving Universal Health Coverage in Colorado - Kaiser Permanente
4) Comprehensive Health Care Plan for CO - Club 20
5) An Individual Based Insurance System Combining Free Market Principles with an Appropriate Role for Government - South Metro Denver Chamber of Commerce
6) Connecting Care and Health for Colorado - CCHI
7) Community of Caring – Colorado Community health Network
8) A Plan for Covering Coloradans - Committee for Colorado Health Care Solutions (Barbara Yondorf is very fond of this plan)
9) Healthy CO Now - CCMU
10) CO Health Services Program – HCAC
plus:
11) FAIR — Brian Schwartz
Number eleven, a libertarian free-market plan submitted by Brian Schwartz only received two votes out of more than 150 possible (each commissioner present — 22 or so — could vote on seven proposals). For the most part, only plans that received 10 or more votes were passed. However, libertarian commissioner Linda Gorman said there was no need for her to return if it weren’t chosen and so it became the 11th proposal to remain.
There was almost no public comment during this meeting, and thus commissioners’ remarks, some of which mixed up proposals or included misinformation, went unchallenged.
Commissioners spent a lot of time comparing the single payer proposals, as most agreed that one of them should be chosen for evaluation. The six pure single-payer proposals together garnered 22 votes — 26 if Balanced Choice is counted. That meant that the single-payer type of reform got more votes than any other single category other than one. The commissioners said that proposals 16, 17, and 18 were very similar. (Those were from Health Care for All Colorado; Stuart Zisman, a professor at the University of Northern Colorado; and Nathan Wilkes, whose 3-year-old son's hemophilia has meant that the Wilkes not only have to gather their strength to best care for the physical needs of their son, but that they also must frantically scramble — every year — to keep insurance. I can't imagine the stress.)
During the single-payer discussion, Linda Gorman opined that there are two kinds of single payer, one with no private market competition, as in Canada, she said, and the NHS model, as in Great Britain. She differentiated between Wilkes’ and HCAC’s plan, saying that Wilkes’ plan was more like the Canadian model with "no competition."
Regarding HCAC's plan, she said it is problematic to limit spending to the growth in GDP.
Commissioner Alan Jensen, a health insurance underwriter, remarked that Wilkes' proposal, like the Canadian model, takes away the ability to choose providers. (These remarks obviously indicate misunderstanding about single payer and the Canadian system.)
Sarah Schulte, the commission's technical advisor, noted that HCAC's plan had no copays, whereas the Zisman plan did.
Commissioners liked another single- payer plan's focus on promoting wellness. (That plan being from retired CU professor Edwin McConkey.)
Another commissioner stated that HCAC's plan has more explicit benefits (that can be redefined) and a stronger program of reimbursement based on providers' quality of care.
Commissioner Mark Simon commented that he likes the HCAC plan except for the lack of consumer oversight of the program. He did not like the political appointment of the governing board.
Commissioner Elisabeth Arenales suggested that the HCAC plan would be the right single-payer plan to go with because of the group’s strong organization and support.
Commissioner Arnold Salazar said that consideration would make him vote against the HCAC plan.
Arenales countered that the commission was hoping to get a plan through the legislature, and that strong organizational support, such as that provided by HCAC, would help make that happen.
Commissioners decided to go with the HCAC plan as their single-payer model chosen even though commissioners liked many of the points in other single-payer plans.
Although the commissioners did not categorize the Balanced Choice plan as being a single-payer, they liked its rich benefits package and specification of itemized bills to patients to control fraud. Simon spoke to the risk of a two-tiered system of health care; he also praised it as the only plan that addressed non-residents.
Sarah Schulte, the technical advisor, rated a single-payer plan submitted by PULSE highest of all 28 plans.
Of the nine plans that Schulte scored as having at least two “high”s and no “low”s, five were single-payer plans: those submitted by HCAC, PULSE, Edwin McConkey, Nathan Wilkes, and Stuart Zisman.
The other four plans that scored high were those from Kaiser, the South Metro Chamber of Commerce, the Colorado Community Health Network, and the Committee for Colorado Health Care Solutions.
When commissioners voted on the plans, the results were far different.
HCAC’s plan and Stuart Zisman’s plan each got six votes; Nathan Wilkes’ plan and the Balanced Choice plans received four votes each, and Edwin McConkey’s plan received three votes.
Although the PULSE plan received only two votes, the commissioners were reluctant to take it off the table because of its innovative methods, specifically, the idea of a health care team of physician, nurse, social worker, and ombudsman. One commissioner remarked that PULSE was the only plan limiting administrative costs.
High vote getters (from 10 to 14 votes each) included the four non-single-payer plans that Schulte rated high, but also plans from SEIU (the Service Employees International Union), Club 20 (a conservative business group from Western Colorado), Colorado Consumer Health Initiative, and the Colorado Coalition for the Medically Underserved.
Several commissioners said that core benefit of the Insurance Underwriters' proposal was inadequate (capped at $50,000 a year, which Simon said was sure to create more uninsured). Commissioner Jensen, who has been chair of the underwriters, said at an earlier commission meeting that there is no need for comprehensive reform; one or two changes would reform health care. This proposal received seven votes.
1) Better Health Care for CO - SEIU
2) Solutions for a Healthy Colorado - CO State Association of Health Underwriters
3) A Phased Approach to Achieving Universal Health Coverage in Colorado - Kaiser Permanente
4) Comprehensive Health Care Plan for CO - Club 20
5) An Individual Based Insurance System Combining Free Market Principles with an Appropriate Role for Government - South Metro Denver Chamber of Commerce
6) Connecting Care and Health for Colorado - CCHI
7) Community of Caring – Colorado Community health Network
8) A Plan for Covering Coloradans - Committee for Colorado Health Care Solutions (Barbara Yondorf is very fond of this plan)
9) Healthy CO Now - CCMU
10) CO Health Services Program – HCAC
plus:
11) FAIR — Brian Schwartz
Number eleven, a libertarian free-market plan submitted by Brian Schwartz only received two votes out of more than 150 possible (each commissioner present — 22 or so — could vote on seven proposals). For the most part, only plans that received 10 or more votes were passed. However, libertarian commissioner Linda Gorman said there was no need for her to return if it weren’t chosen and so it became the 11th proposal to remain.
There was almost no public comment during this meeting, and thus commissioners’ remarks, some of which mixed up proposals or included misinformation, went unchallenged.
Commissioners spent a lot of time comparing the single payer proposals, as most agreed that one of them should be chosen for evaluation. The six pure single-payer proposals together garnered 22 votes — 26 if Balanced Choice is counted. That meant that the single-payer type of reform got more votes than any other single category other than one. The commissioners said that proposals 16, 17, and 18 were very similar. (Those were from Health Care for All Colorado; Stuart Zisman, a professor at the University of Northern Colorado; and Nathan Wilkes, whose 3-year-old son's hemophilia has meant that the Wilkes not only have to gather their strength to best care for the physical needs of their son, but that they also must frantically scramble — every year — to keep insurance. I can't imagine the stress.)
During the single-payer discussion, Linda Gorman opined that there are two kinds of single payer, one with no private market competition, as in Canada, she said, and the NHS model, as in Great Britain. She differentiated between Wilkes’ and HCAC’s plan, saying that Wilkes’ plan was more like the Canadian model with "no competition."
Regarding HCAC's plan, she said it is problematic to limit spending to the growth in GDP.
Commissioner Alan Jensen, a health insurance underwriter, remarked that Wilkes' proposal, like the Canadian model, takes away the ability to choose providers. (These remarks obviously indicate misunderstanding about single payer and the Canadian system.)
Sarah Schulte, the commission's technical advisor, noted that HCAC's plan had no copays, whereas the Zisman plan did.
Commissioners liked another single- payer plan's focus on promoting wellness. (That plan being from retired CU professor Edwin McConkey.)
Another commissioner stated that HCAC's plan has more explicit benefits (that can be redefined) and a stronger program of reimbursement based on providers' quality of care.
Commissioner Mark Simon commented that he likes the HCAC plan except for the lack of consumer oversight of the program. He did not like the political appointment of the governing board.
Commissioner Elisabeth Arenales suggested that the HCAC plan would be the right single-payer plan to go with because of the group’s strong organization and support.
Commissioner Arnold Salazar said that consideration would make him vote against the HCAC plan.
Arenales countered that the commission was hoping to get a plan through the legislature, and that strong organizational support, such as that provided by HCAC, would help make that happen.
Commissioners decided to go with the HCAC plan as their single-payer model chosen even though commissioners liked many of the points in other single-payer plans.
Although the commissioners did not categorize the Balanced Choice plan as being a single-payer, they liked its rich benefits package and specification of itemized bills to patients to control fraud. Simon spoke to the risk of a two-tiered system of health care; he also praised it as the only plan that addressed non-residents.
Sarah Schulte, the technical advisor, rated a single-payer plan submitted by PULSE highest of all 28 plans.
Of the nine plans that Schulte scored as having at least two “high”s and no “low”s, five were single-payer plans: those submitted by HCAC, PULSE, Edwin McConkey, Nathan Wilkes, and Stuart Zisman.
The other four plans that scored high were those from Kaiser, the South Metro Chamber of Commerce, the Colorado Community Health Network, and the Committee for Colorado Health Care Solutions.
When commissioners voted on the plans, the results were far different.
HCAC’s plan and Stuart Zisman’s plan each got six votes; Nathan Wilkes’ plan and the Balanced Choice plans received four votes each, and Edwin McConkey’s plan received three votes.
Although the PULSE plan received only two votes, the commissioners were reluctant to take it off the table because of its innovative methods, specifically, the idea of a health care team of physician, nurse, social worker, and ombudsman. One commissioner remarked that PULSE was the only plan limiting administrative costs.
High vote getters (from 10 to 14 votes each) included the four non-single-payer plans that Schulte rated high, but also plans from SEIU (the Service Employees International Union), Club 20 (a conservative business group from Western Colorado), Colorado Consumer Health Initiative, and the Colorado Coalition for the Medically Underserved.
Several commissioners said that core benefit of the Insurance Underwriters' proposal was inadequate (capped at $50,000 a year, which Simon said was sure to create more uninsured). Commissioner Jensen, who has been chair of the underwriters, said at an earlier commission meeting that there is no need for comprehensive reform; one or two changes would reform health care. This proposal received seven votes.
30 April 2007
28 proposals to the 208 Commission
A smart healthcare provider in Boulder, Colorado, has summarized all 28 of the healthcare proposals that the Colorado Blue Ribbon Commission for Health Care Reform is considering.
The fact that there are 28 proposals is in itself amazing. At one of the early commission meetings a staff person reported on similar commissions in other states. Illinois got nine proposals, so did California. Washington got more, but they weren't calling for comprehensive proposals, as is the Colorado commission.
You can find the 28 proposals submitted to the 208 Commission here.
This woman works with one of the proposers, but notes that these are her own impressions — and she says that they may not be fair, since she's working from descriptions of the plans, rather than reading each and every plan. She shares her biases up front: "I think of 'premium assistance' to individuals or small businesses r the 'uninsurable').
"Many mentioned the desirability of “medical homes” of some sort, which would serve to coordinate care for patients.
"Many would increase reimbursements to Medicaid and/or Medicare providers to address the problems of inadequate access to providers. Also mentioned frequently were incentives for healthy choices, and some pay-for performance suggestions. A couple of proposals suggested limiting profits that insurance companies make."
So, cribbing from her notes, here are the 28, organized, as she organized them.
Types of Proposals
Predominately Single-Payer
Colorado Health Services, submitted by Health Care for All Colorado and signed on to by the Colorado Nurses Association, OWL, and the Physicians for a National Health Program. Publicly owned, not-for-profit insurance company, administered and governed as public utility. Negotiated provider fees, no co-pays to begin with. Private coverage will be a choice above standard benefits.
Comprehensive Health Advancement Plan for Colorado, submitted by retired University of Colorado professor Edwin McConkey. This is a modified single-payer with emphasis on health advancement rather than insurance. There are financial incentives for healthy lifestyles and training of professionals in high needs areas. It creates a new agency with state wide governance, public funds, set fees for providers.
Colorado Complete Healthcare Reform, submitted by PULSE. Expands Medicaid to all residents in a program called MediColo but allows insurance companies to operate in Colorado for up to five years. There would be a no-fault system that separates compensation from accountability which would reduce malpractice costs. Its medical home is a team of MD, nurse, social worker or counselor and advocate.
Colorado Comprehensive Care Coverage, submitted by Savant Solutions. Its state-run, paperless, profitless, models are Medicaid, VA, Kaiser and European countries. It would begin with a pilot project with four phases. An oversight group such as Savant, would serve as a procurement team requesting RFPs, getting bids, selecting them.
Colorado All Care, submitted by Nathan Wilkes. Healthcare delivery remains the same but funding would be through taxes. Reimbursement rates to providers would be set; there would be no co-pay or deductibles; all prescription, dental, vision, mental health, and long term care would be covered.
Universal Capitation Plan, submitted by Stuart Zisman. This single-payer plan is similar to HCAC proposal except that it's run by elected providers and consumers, with local assessments of needs and consumer choice of fee-for-service or a capitated-rate (recommended) plan.
Single-Payer with market component
Colorado Balanced Choice Health Care Reform, submitted by Balanced Choice Health Care, Inc. Ivan Miller's plan offers universal coverage, public funding, single-payer with a constant option of interchanging a two-plan system that allows for providers to set their own fees and for consumers to have cost conscious treatment choices. Spending on the two plans would be regulated by a mandatory funding split that adapts to market forces to ensure enough resources go to the standard plan to maintain quality care. There would be a focus on transparency, automatic enrollment (with opt-out possibilities if they have equivalent or better health insurance) so all residents are covered regardless of employment or income status, simplified paperwork and procedures, and relief for employers. Financial assistance for low income or catastrophic health expenses.
Predominately Subsidizing Private Insurance
A Comprehensive Health Care Plan for All Colorado Residents, submitted by Barry Bode. This comprehensive reform proposal would subsidize health, disability and life insurance.
Comprehensive Health Care Plan, submitted by Club 20. This plan mandates individual purchase of basic “Tier I” coverage as in Massachusetts. It uses value ranking procedures as in Oregon, which is a transparent way of limiting or rationing treatment. The plan states that the healthcare “...solution is less about need for new ideas and more about need to accept reality.”
A Plan for Covering Coloradans, submitted by the Committee for Colorado Health Care Solutions. This plan creates the Colorado Health Insurance Purchasing Authority, a quasi-governmental agency to standardize six to ten insurance benefit packages, assist with purchases of insurance, manage the insurance “pool” with community ratings and guarantee issue. The proposer believes that national policy is necessary. This plan has aspects of single-payer and expanding public coverage but remains a broker/ regulatory agency to oversee private insurance.
Solutions for Healthy Colorado, submitted by the Colorado State Association of Health Underwriters. This proposal would institute state-sponsored outreach for those eligible but not enrolled in public programs; insurance companies must guarantee issue “Core Limited Benefit Plan” with sliding scale premium subsidies; and mandated individual purchase to address the “voluntarily uninsured.” Plan lacks details.
Better Health Care for Colorado, submitted by the Service Employees Union (SEIU) and the Colorado Association of Public Employees. This plan would bring Medicaid-funded premium subsidies to purchase insurance; establish a clearinghouse to help small business purchase health insurance and offer private insurance products rather than mandating insurance. It would create a “culture of insurance” and extend coverage to 96 percent of residents. Recipients would have choice of managed care plans. It does provide long-term care plans and urges improved access to affordable housing so long-term care consumers can live independently.
Individual Based Insurance System Combining Free market Principles with Appropriate Role for Government, submitted by the South Metro Denver Chamber of Commerce. This plan mandates individual purchase of “maintenance tier” insurance not tied to employer. There would be a Massachusetts-style health connector portal and search engine that provides healthcare purchasing consultants. There would be group pools for catastrophic insurance that is re-insurance funded by contributions from the maintenance policies. The free market moves responsibility from managed care to the individual and eliminates inefficiencies. There is a heavy emphasis on HIT and incentives. A statewide system of clinics funded by the state, business gifts, and non-profit donations would serve the uninsured/minimally insured.
Universal Colorado Health Insurance Plan, submitted by Joseph Roddy and William Yancey. This plan would “fine tune the industry with regulation to... serve the entire population...” It puts people into groups of 10,000 with identical demographics so that the premium price is the same for everyone. Insurance companies decide how many groups to compete in. Providers are exempt from malpractice claims.
Combination of Expanded Public and Subsidizing Private
Uninsured Action Plan, submitted by Anthem BC/BS (Wellpoint). This plan expands CHP+ and Medicaid; subsidizes private insurance; increases managed-care; and “minimizes administrative costs by building on existing systems.”
Connecting Care and Health for Colorado, submitted by Colorado Consumer Health Initiative (CCHI), also signed by Health Care Policy and Finance, Division of Insurance, Department of Public Health and Dept. of Human Services. This government-run plan limits the profits insurance companies can make. It standardize benefit packages in both public and private markets and mandates individual purchase with limits of 5 percent of income for out-of-pocket costs. It builds on employer-sponsored plans with subsidies and/or reinsurance and consumer protections.
Healthy Colorado Now, submitted by the Coalition for the Medically Underserved. CCMU builds on our existing system but develops a new insurance plan for the working uninsured, funded by employer-paid payroll fees, which does provide premium assistance if necessary. This may be private insurance.
Community of Caring, submitted by the Colorado Community Health Network, Colorado Children’s Campaign, Colorado Access, and Colorado Behavioral Health Council. This plan calls for mandated individual insurance purchase with subsidies for individual and small business insurance purchases. A “quasi-governmental” entity creates a public-private partnership to purchase coverage for all Coloradans (except ERISA) and it expands public programs. They propose a “Safety Net Stabilization Program” which provides enhanced reimbursements to providers certified to meet needs of distinct populations.
Phased Approach to Universal Coverage, submitted by Kaiser Permanente. This plan expands public programs as funds permit, and creates policy and administrative infrastructures.
Additional but not Comprehensive Proposals
Improving Our Health Care and Condition, submitted by the Colorado Foundation for Medical Care. This plan would provides foundational elements essential to quality and functioning of health care systems.
System to Ensure Medical Home—Health Outcomes Measurement and Evaluation Consortium, submitted by Health TransPharmacy Care Fund. This proposal provides information on available resources, access to pharmacy savings program and subsidies.
Neighborhood Nurse Practitioner Clinics Mandating private health insurance “is absolutely the wrong approach [it] is the problem, not the solution” so neighborhood groups of 500 households would join a clinic for $25/month and receive unlimited free office visits with nurse practitioners. The $25/month would pay for a NP, part-time office staff and overhead, which is low because it operates out of a residence. Insurance would cover catastrophic care.
Free-market, Affordability and Individual Rights, submitted by Brian Schwartz. The fault for unaffordable healthcare lies in third party payments that delete personal responsibility
A Simple Health Care Solution, submitted by Monte Uyemura, MD. This proposal would make it illegal to sue providers and would eliminate physician shortage. In exchange providers could not refuse to see patients for inability to pay. It calls for major medical and HSAs to reduce paperwork.
Colorado Health Coverage and Jobs Solution, has no name on the submission. It requires insurance firms having government contracts to offer a plan comparable in price and benefits to Federal Employees Health Benefit Plan.
Telemedicine and Data management Systems for Improvement of HC Coverage Costs, submitted byEnigami Systems. This patent-pending protocol is a plan in which consumers' symptoms are telephonically assessed on a daily basis using interactive voice response system that can be viewed graphically on the web-site by the consumer. This addresses inadequate accountability; allows provider to change treatment plan and allows insurer to do utilization reviews and provider rating scales
The Option to Die in Peace, submitted by Bart Windrum. This proposes expanded hospice-type education and care for at-home deaths.
The fact that there are 28 proposals is in itself amazing. At one of the early commission meetings a staff person reported on similar commissions in other states. Illinois got nine proposals, so did California. Washington got more, but they weren't calling for comprehensive proposals, as is the Colorado commission.
You can find the 28 proposals submitted to the 208 Commission here.
This woman works with one of the proposers, but notes that these are her own impressions — and she says that they may not be fair, since she's working from descriptions of the plans, rather than reading each and every plan. She shares her biases up front: "I think of 'premium assistance' to individuals or small businesses r the 'uninsurable').
"Many mentioned the desirability of “medical homes” of some sort, which would serve to coordinate care for patients.
"Many would increase reimbursements to Medicaid and/or Medicare providers to address the problems of inadequate access to providers. Also mentioned frequently were incentives for healthy choices, and some pay-for performance suggestions. A couple of proposals suggested limiting profits that insurance companies make."
So, cribbing from her notes, here are the 28, organized, as she organized them.
Colorado Health Services, submitted by Health Care for All Colorado and signed on to by the Colorado Nurses Association, OWL, and the Physicians for a National Health Program. Publicly owned, not-for-profit insurance company, administered and governed as public utility. Negotiated provider fees, no co-pays to begin with. Private coverage will be a choice above standard benefits.
Comprehensive Health Advancement Plan for Colorado, submitted by retired University of Colorado professor Edwin McConkey. This is a modified single-payer with emphasis on health advancement rather than insurance. There are financial incentives for healthy lifestyles and training of professionals in high needs areas. It creates a new agency with state wide governance, public funds, set fees for providers.
Colorado Complete Healthcare Reform, submitted by PULSE. Expands Medicaid to all residents in a program called MediColo but allows insurance companies to operate in Colorado for up to five years. There would be a no-fault system that separates compensation from accountability which would reduce malpractice costs. Its medical home is a team of MD, nurse, social worker or counselor and advocate.
Colorado Comprehensive Care Coverage, submitted by Savant Solutions. Its state-run, paperless, profitless, models are Medicaid, VA, Kaiser and European countries. It would begin with a pilot project with four phases. An oversight group such as Savant, would serve as a procurement team requesting RFPs, getting bids, selecting them.
Colorado All Care, submitted by Nathan Wilkes. Healthcare delivery remains the same but funding would be through taxes. Reimbursement rates to providers would be set; there would be no co-pay or deductibles; all prescription, dental, vision, mental health, and long term care would be covered.
Universal Capitation Plan, submitted by Stuart Zisman. This single-payer plan is similar to HCAC proposal except that it's run by elected providers and consumers, with local assessments of needs and consumer choice of fee-for-service or a capitated-rate (recommended) plan.
Colorado Balanced Choice Health Care Reform, submitted by Balanced Choice Health Care, Inc. Ivan Miller's plan offers universal coverage, public funding, single-payer with a constant option of interchanging a two-plan system that allows for providers to set their own fees and for consumers to have cost conscious treatment choices. Spending on the two plans would be regulated by a mandatory funding split that adapts to market forces to ensure enough resources go to the standard plan to maintain quality care. There would be a focus on transparency, automatic enrollment (with opt-out possibilities if they have equivalent or better health insurance) so all residents are covered regardless of employment or income status, simplified paperwork and procedures, and relief for employers. Financial assistance for low income or catastrophic health expenses.
A Comprehensive Health Care Plan for All Colorado Residents, submitted by Barry Bode. This comprehensive reform proposal would subsidize health, disability and life insurance.
Comprehensive Health Care Plan, submitted by Club 20. This plan mandates individual purchase of basic “Tier I” coverage as in Massachusetts. It uses value ranking procedures as in Oregon, which is a transparent way of limiting or rationing treatment. The plan states that the healthcare “...solution is less about need for new ideas and more about need to accept reality.”
A Plan for Covering Coloradans, submitted by the Committee for Colorado Health Care Solutions. This plan creates the Colorado Health Insurance Purchasing Authority, a quasi-governmental agency to standardize six to ten insurance benefit packages, assist with purchases of insurance, manage the insurance “pool” with community ratings and guarantee issue. The proposer believes that national policy is necessary. This plan has aspects of single-payer and expanding public coverage but remains a broker/ regulatory agency to oversee private insurance.
Solutions for Healthy Colorado, submitted by the Colorado State Association of Health Underwriters. This proposal would institute state-sponsored outreach for those eligible but not enrolled in public programs; insurance companies must guarantee issue “Core Limited Benefit Plan” with sliding scale premium subsidies; and mandated individual purchase to address the “voluntarily uninsured.” Plan lacks details.
Better Health Care for Colorado, submitted by the Service Employees Union (SEIU) and the Colorado Association of Public Employees. This plan would bring Medicaid-funded premium subsidies to purchase insurance; establish a clearinghouse to help small business purchase health insurance and offer private insurance products rather than mandating insurance. It would create a “culture of insurance” and extend coverage to 96 percent of residents. Recipients would have choice of managed care plans. It does provide long-term care plans and urges improved access to affordable housing so long-term care consumers can live independently.
Individual Based Insurance System Combining Free market Principles with Appropriate Role for Government, submitted by the South Metro Denver Chamber of Commerce. This plan mandates individual purchase of “maintenance tier” insurance not tied to employer. There would be a Massachusetts-style health connector portal and search engine that provides healthcare purchasing consultants. There would be group pools for catastrophic insurance that is re-insurance funded by contributions from the maintenance policies. The free market moves responsibility from managed care to the individual and eliminates inefficiencies. There is a heavy emphasis on HIT and incentives. A statewide system of clinics funded by the state, business gifts, and non-profit donations would serve the uninsured/minimally insured.
Universal Colorado Health Insurance Plan, submitted by Joseph Roddy and William Yancey. This plan would “fine tune the industry with regulation to... serve the entire population...” It puts people into groups of 10,000 with identical demographics so that the premium price is the same for everyone. Insurance companies decide how many groups to compete in. Providers are exempt from malpractice claims.
Uninsured Action Plan, submitted by Anthem BC/BS (Wellpoint). This plan expands CHP+ and Medicaid; subsidizes private insurance; increases managed-care; and “minimizes administrative costs by building on existing systems.”
Connecting Care and Health for Colorado, submitted by Colorado Consumer Health Initiative (CCHI), also signed by Health Care Policy and Finance, Division of Insurance, Department of Public Health and Dept. of Human Services. This government-run plan limits the profits insurance companies can make. It standardize benefit packages in both public and private markets and mandates individual purchase with limits of 5 percent of income for out-of-pocket costs. It builds on employer-sponsored plans with subsidies and/or reinsurance and consumer protections.
Healthy Colorado Now, submitted by the Coalition for the Medically Underserved. CCMU builds on our existing system but develops a new insurance plan for the working uninsured, funded by employer-paid payroll fees, which does provide premium assistance if necessary. This may be private insurance.
Community of Caring, submitted by the Colorado Community Health Network, Colorado Children’s Campaign, Colorado Access, and Colorado Behavioral Health Council. This plan calls for mandated individual insurance purchase with subsidies for individual and small business insurance purchases. A “quasi-governmental” entity creates a public-private partnership to purchase coverage for all Coloradans (except ERISA) and it expands public programs. They propose a “Safety Net Stabilization Program” which provides enhanced reimbursements to providers certified to meet needs of distinct populations.
Phased Approach to Universal Coverage, submitted by Kaiser Permanente. This plan expands public programs as funds permit, and creates policy and administrative infrastructures.
Improving Our Health Care and Condition, submitted by the Colorado Foundation for Medical Care. This plan would provides foundational elements essential to quality and functioning of health care systems.
System to Ensure Medical Home—Health Outcomes Measurement and Evaluation Consortium, submitted by Health TransPharmacy Care Fund. This proposal provides information on available resources, access to pharmacy savings program and subsidies.
Neighborhood Nurse Practitioner Clinics Mandating private health insurance “is absolutely the wrong approach [it] is the problem, not the solution” so neighborhood groups of 500 households would join a clinic for $25/month and receive unlimited free office visits with nurse practitioners. The $25/month would pay for a NP, part-time office staff and overhead, which is low because it operates out of a residence. Insurance would cover catastrophic care.
Free-market, Affordability and Individual Rights, submitted by Brian Schwartz. The fault for unaffordable healthcare lies in third party payments that delete personal responsibility
A Simple Health Care Solution, submitted by Monte Uyemura, MD. This proposal would make it illegal to sue providers and would eliminate physician shortage. In exchange providers could not refuse to see patients for inability to pay. It calls for major medical and HSAs to reduce paperwork.
Colorado Health Coverage and Jobs Solution, has no name on the submission. It requires insurance firms having government contracts to offer a plan comparable in price and benefits to Federal Employees Health Benefit Plan.
Telemedicine and Data management Systems for Improvement of HC Coverage Costs, submitted byEnigami Systems. This patent-pending protocol is a plan in which consumers' symptoms are telephonically assessed on a daily basis using interactive voice response system that can be viewed graphically on the web-site by the consumer. This addresses inadequate accountability; allows provider to change treatment plan and allows insurer to do utilization reviews and provider rating scales
The Option to Die in Peace, submitted by Bart Windrum. This proposes expanded hospice-type education and care for at-home deaths.
24 April 2007
One size does fit all
We now know part of the health insurance industry's talking points regarding what's the matter with U.S. healthcare: It's that one size doesn't fit all when it comes to health insurance.
What a crock.
How does one size not fit all? Which one of us doesn't want care when we're sick or injured? This was the answer that the journalist bought in the New York Magazine article on "the young invincibles" and here's a reporter for the Indy Star giving a platform to Wellpoint to make the same point.
And that is OF COURSE the end game for the health insurance industry. They'll insure all the healthy people, and the government can take care of all the sick people. What a deal.
Don McCanne, former president of Physicians for a National Health Program, had a good post on this today. Sign up for those posts through this link from the PNHP website.
What a crock.
How does one size not fit all? Which one of us doesn't want care when we're sick or injured? This was the answer that the journalist bought in the New York Magazine article on "the young invincibles" and here's a reporter for the Indy Star giving a platform to Wellpoint to make the same point.
Jude Thompson, president of individual markets for WellPoint, the nation's largest health insurer, said the traditional one-size-fits-all approach to marketing insurance no longer works.What Jude is talking about, of course, is actually "the choice" to pay less for a higher deductible and catastrophic coverage only — which hardly makes insurance more cost effective. It's still "playing the odds," just as people without insurance do. It still essentially takes people out of the risk pool, meaning that someone with a chronic condition who needs care will certainly be left in a market where that care is unaffordable — unless the government picks it up.
"That's one of the big reasons why we're where we are today with the uninsured," he said. "Companies need to change the way they are talking about insurance and offer different products with different price points. We need products that resonate with the different age and income groups and hit the mark with people who can and want to purchase insurance."
And that is OF COURSE the end game for the health insurance industry. They'll insure all the healthy people, and the government can take care of all the sick people. What a deal.
Don McCanne, former president of Physicians for a National Health Program, had a good post on this today. Sign up for those posts through this link from the PNHP website.
16 April 2007
Blackout on the truth
The National Education Association supports single-payer, universal healthcare. Who knew?
And that's the point. We didn't know. The media has effected such an effective blackout on single-payer that it seems like a silly, socialist, pie-in-the-sky idea. Then you dig in a bit and find out that the former head of Caterpillar has said single-payer's what we need, it's the only thing that makes sense; you find out that Ford Motors' former CEO has said much the same thing; that the nurses associations are for it and that the NEA backs single-payer.
But common wisdom still would have it that anyone who thinks single-payer is the solution to our healthcare Catch-22s is unrealistic — when in fact it's unrealistic to think that anything other than single-payer will contain costs and provide healthcare justice.
That doesn't mean that rich people don't get more healthcare under single-payer systems. That's just life. Rich people will always get more. As it turns out, however, more isn't always better. Too bad for them. No doubt when they figure out how to stay young for 50 extra years it won't be covered. That's fine — we're just looking for a normal life-span, like not dying at age 45.
I talked with a woman (we'll call her Julie) from Pueblo, Colorado, tonight. Julie's worried sick about her mother's health. Her dad gets health insurance through the government because he's disabled. He makes $7 and some change an hour. Julie says her mother's salary always supported the family, and that her mom has always gotten her own healthcare through a clinic for the indigent. Now Julie doesn't know what to do, because her mother is sick. Julie herself is a single parent, a junior in college on a scholarship that doesn't pay for her mother's healthcare.
Julie says that politicians keep talking about covering the kids. Good, she says, but it's not enough. "What are people supposed to do between the ages of 18 and 65?"
Julie says that she's heard the horror stories about people having to wait for surgery in countries that have healthcare justice, but that she's talked with people from Britain and elsewhere, who tell her it's not like that at all. "They say it's us that have the crazy system."
And that's the point. We didn't know. The media has effected such an effective blackout on single-payer that it seems like a silly, socialist, pie-in-the-sky idea. Then you dig in a bit and find out that the former head of Caterpillar has said single-payer's what we need, it's the only thing that makes sense; you find out that Ford Motors' former CEO has said much the same thing; that the nurses associations are for it and that the NEA backs single-payer.
But common wisdom still would have it that anyone who thinks single-payer is the solution to our healthcare Catch-22s is unrealistic — when in fact it's unrealistic to think that anything other than single-payer will contain costs and provide healthcare justice.
That doesn't mean that rich people don't get more healthcare under single-payer systems. That's just life. Rich people will always get more. As it turns out, however, more isn't always better. Too bad for them. No doubt when they figure out how to stay young for 50 extra years it won't be covered. That's fine — we're just looking for a normal life-span, like not dying at age 45.
I talked with a woman (we'll call her Julie) from Pueblo, Colorado, tonight. Julie's worried sick about her mother's health. Her dad gets health insurance through the government because he's disabled. He makes $7 and some change an hour. Julie says her mother's salary always supported the family, and that her mom has always gotten her own healthcare through a clinic for the indigent. Now Julie doesn't know what to do, because her mother is sick. Julie herself is a single parent, a junior in college on a scholarship that doesn't pay for her mother's healthcare.
Julie says that politicians keep talking about covering the kids. Good, she says, but it's not enough. "What are people supposed to do between the ages of 18 and 65?"
Julie says that she's heard the horror stories about people having to wait for surgery in countries that have healthcare justice, but that she's talked with people from Britain and elsewhere, who tell her it's not like that at all. "They say it's us that have the crazy system."
11 April 2007
Lack of health insurance = more strokes
A study out of Beth Israel Hospital, Harvard, and several other facilities has found that people without health insurance don't get routine physical exams and have increased rates of stroke and death. The researchers reported their findings in the April issue of the Journal of General Internal Medicine.
Imagine that. Wasn't it just last week that a couple of Cato anti-single-payer "experts" wrote in the LA Times that there was no connection between people's health and insurance? In which case, why buy insurance? Especially since, in the America that anti-single-payer folks live in, we already have universal healthcare. And black is white, peace is war, up is down, there were weapons of mass destruction, and Bush is our greatest president.
Who was it who said that everyone's entitled to their own opinion, but that no one is entitled to their own facts?
Imagine that. Wasn't it just last week that a couple of Cato anti-single-payer "experts" wrote in the LA Times that there was no connection between people's health and insurance? In which case, why buy insurance? Especially since, in the America that anti-single-payer folks live in, we already have universal healthcare. And black is white, peace is war, up is down, there were weapons of mass destruction, and Bush is our greatest president.
Who was it who said that everyone's entitled to their own opinion, but that no one is entitled to their own facts?
10 April 2007
'Sick' author Cohn at TPMCafe
Jonathan Cohn's new book, Sick, is this week's book club item over at TPMCafe. Jacob Hacker, Ezra Klein, Matthew Holt, Robin Podolsky, Don McCanne, Roger Hickey, Maggie Mahar and Joseph Paduda will debate Cohn on the options: single-payer, hybrid, or social Darwinism.
Cohn writes, "One of the most striking things about the hybrid crowd is how many of them actually believe, in their hearts, that single-payer is better. For these people, endorsing a hybrid is all about political calculation: Single-payer won't pass, so it's better to get behind a workable compromise."
He thinks that's a mistake: "For one thing, a discussion about changing public policy ought to start with a discussion about which policy would actually work best, whatever the politics."
Cohn refers to his NYT Magazine interview with Safeway CEO Steve Burd, who joined with Andy Stern of SEIU and Sen. Ron Wyden (D-OR) to call for universal healthcare. Burd didn't want to look to government. First he pushed personal responsibility in the form of forcing employees to cover more of their own costs, and then he pushed personal responsibility in the form of employees adopting healthy habits. But it's not enough, is it?
Well then why hasn't it? Or more to the point, why has single-payer kept costs down wherever it exists? As it covers everyone? Why hasn't "moral hazard" shot their costs out of the ballpark? Why have their outcomes remained as good or better than ours? For half the cost?
Lastly, how is the health insurance market different than a protection racket? Wouldn't it be better, in the long run, to set up a police department rather than relying on the Sopranos?
Cohn writes, "One of the most striking things about the hybrid crowd is how many of them actually believe, in their hearts, that single-payer is better. For these people, endorsing a hybrid is all about political calculation: Single-payer won't pass, so it's better to get behind a workable compromise."
He thinks that's a mistake: "For one thing, a discussion about changing public policy ought to start with a discussion about which policy would actually work best, whatever the politics."
Cohn refers to his NYT Magazine interview with Safeway CEO Steve Burd, who joined with Andy Stern of SEIU and Sen. Ron Wyden (D-OR) to call for universal healthcare. Burd didn't want to look to government. First he pushed personal responsibility in the form of forcing employees to cover more of their own costs, and then he pushed personal responsibility in the form of employees adopting healthy habits. But it's not enough, is it?
In conversations around the Bay Area, [Burd] heard over and over from hospital administrators about the financial burden the uninsured were placing on their facilities — a burden that eventually rippled through the insurance system and showed up on Safeway’s bottom line as inflated health premiums.It's striking how many of the comments to Cohn's TPM piece push the free market mantra. Of course it can push down costs...
Burd’s first effort to trim costs and keep Safeway competitive involved cutting back on health benefits. Then he tried encouraging his workers to be healthier. Could nationwide universal health care simply be the next step? As long as there were large numbers of uninsured, Burd reasoned, there would be no solution to his company’s — or the country’s — problems with affordable care. And that, he says, is when it finally dawned on him: Maybe this was a problem the company couldn’t solve on its own. If he wanted relief from employee health costs, the government would have to help.
It was not an idea that came easily to Burd, a self-described conservative and Republican...
Well then why hasn't it? Or more to the point, why has single-payer kept costs down wherever it exists? As it covers everyone? Why hasn't "moral hazard" shot their costs out of the ballpark? Why have their outcomes remained as good or better than ours? For half the cost?
Lastly, how is the health insurance market different than a protection racket? Wouldn't it be better, in the long run, to set up a police department rather than relying on the Sopranos?
06 April 2007
Right resorts to lies
A couple of Cato Institute directors have resorted to half-truths and lies in an op-ed piece for the LA Times. The piece is titled "Universal health care's dirty little secrets" — those "secrets" evidently being foremost that preventive care doesn't make for healthier populations.
Ezra Klein does a good job of rebutting this, saying that the Cato guys distorted the study that supposedly proved this — and ignored the many studies that show positive correlations between preventive care and better health.
The other "dirty secrets" are similarly deceitful — beginning with the "fact" that the uninsured in the U.S. do get care in emergency room hospitals and via docs, who don't turn away patients just because they're uninsured. And there are physicians who take on an uninsured friend. But those instances hardly make for a "medical home" for a county's uninsured — especially for the uninsured with chronic conditions.
The Cato guys, of course, fell back on the right's frantic claim that there are waiting lists for elective surgery in countries with universal care. The right screams this so often that it's hardly a secret. They never mention the fact, of course, that there are also waits here in the U.S. — and that waits are hardly a secret in Canada. It's a public system that was underfunded and is now doing far better. Their problems are far more publicized than ours are, because it's public. People got mad about it, and they're fixing it. This is a "secret" only in the upside-down world of libertarians.
So will the Canadian system then be perfect — after they work out the waits? Give me a break. What system is perfect? The point is that the U.S. can do much, much better — and that Canada, Great Britain, Sweden and all the others already do much better. Unless you think that paying more and getting less is better. They have better outcomes for less money in a more transparent (and therefore amenable to improvement) system than ours.
Are we really such idiots that we can't do that too? Are we really so wedded to an inefficient, unjust, and uneven system just because it makes some people a lot of money? And employs — at the expense of lives — thousands of clerks, administrators, and marketing managers? Whatever happened to the joy of creative destruction that the right loves so much when it comes to outsourcing factory jobs? Whatever happened to the concept of retraining people whose skills become obsolete in a new, fast-moving economy that supposedly has to be as efficient as possible in order to compete globally?
Is that true in every sector except healthcare?
At least Amy Ridenour has come up with something new in her never-ending quest to ignore our own crisis and instead focus on the problems of others. Kind of like someone in the Philippines ignoring the hillsides of people living in squatter settlements made of cardboard an discarded mattress springs, saying that these folks are sheltered, after all — but look at the problems in Paris! Where so many people don't have air-conditioning!
Ridenour has dug up a nasty op-ed from the London Times about "mixed-sex wards," that makes it sound as though the British regularly share hospital rooms with sex fiends of the opposite sex. It is a scary story, but hardly, as Ridenour says, the one story you should read about single-payer, if you read nothing else this year. And in fact, a more balanced story from the BBC points out that most "mixed-sex wards" are actually emergency rooms. And I can tell you from recent experience that ours are mixed sex too — and that there is the occasional view of an octogenarian's butt. Big deal.
More recently, the scandal in the British papers about their hospital care is that the telephone charges have been increased. Evidently, it's now possible to spend 60 pence on a call before you're even connected. "It's outrageous!" thundered one letter writer. Indeed. I wonder if Ridenour is aware of that one.
Ezra Klein does a good job of rebutting this, saying that the Cato guys distorted the study that supposedly proved this — and ignored the many studies that show positive correlations between preventive care and better health.
The other "dirty secrets" are similarly deceitful — beginning with the "fact" that the uninsured in the U.S. do get care in emergency room hospitals and via docs, who don't turn away patients just because they're uninsured. And there are physicians who take on an uninsured friend. But those instances hardly make for a "medical home" for a county's uninsured — especially for the uninsured with chronic conditions.
The Cato guys, of course, fell back on the right's frantic claim that there are waiting lists for elective surgery in countries with universal care. The right screams this so often that it's hardly a secret. They never mention the fact, of course, that there are also waits here in the U.S. — and that waits are hardly a secret in Canada. It's a public system that was underfunded and is now doing far better. Their problems are far more publicized than ours are, because it's public. People got mad about it, and they're fixing it. This is a "secret" only in the upside-down world of libertarians.
So will the Canadian system then be perfect — after they work out the waits? Give me a break. What system is perfect? The point is that the U.S. can do much, much better — and that Canada, Great Britain, Sweden and all the others already do much better. Unless you think that paying more and getting less is better. They have better outcomes for less money in a more transparent (and therefore amenable to improvement) system than ours.
Are we really such idiots that we can't do that too? Are we really so wedded to an inefficient, unjust, and uneven system just because it makes some people a lot of money? And employs — at the expense of lives — thousands of clerks, administrators, and marketing managers? Whatever happened to the joy of creative destruction that the right loves so much when it comes to outsourcing factory jobs? Whatever happened to the concept of retraining people whose skills become obsolete in a new, fast-moving economy that supposedly has to be as efficient as possible in order to compete globally?
Is that true in every sector except healthcare?
At least Amy Ridenour has come up with something new in her never-ending quest to ignore our own crisis and instead focus on the problems of others. Kind of like someone in the Philippines ignoring the hillsides of people living in squatter settlements made of cardboard an discarded mattress springs, saying that these folks are sheltered, after all — but look at the problems in Paris! Where so many people don't have air-conditioning!
Ridenour has dug up a nasty op-ed from the London Times about "mixed-sex wards," that makes it sound as though the British regularly share hospital rooms with sex fiends of the opposite sex. It is a scary story, but hardly, as Ridenour says, the one story you should read about single-payer, if you read nothing else this year. And in fact, a more balanced story from the BBC points out that most "mixed-sex wards" are actually emergency rooms. And I can tell you from recent experience that ours are mixed sex too — and that there is the occasional view of an octogenarian's butt. Big deal.
More recently, the scandal in the British papers about their hospital care is that the telephone charges have been increased. Evidently, it's now possible to spend 60 pence on a call before you're even connected. "It's outrageous!" thundered one letter writer. Indeed. I wonder if Ridenour is aware of that one.
05 April 2007
Young invincibles don't need Wellpoint
Infuriating article in New York Magazine on New York's "young invincibles," which is the health insurance industry's term for 20-somethings who make the very rational choice not to buy health insurance to cover themselves and line the pockets of a very profitable industry.
It was a painful article to read, as it opened and closed with the story of Andrew Ondrejcak's bout with appendicitis. He survived.
Paul should have survived too. Would have, if there hadn't been an entire series of screw-ups and wrong judgments at the hospital.
"We trusted them," Sarah told me afterwards. "We trusted them."
Paul had evidently been on some kind of campaign to convince her to be more trusting of people — to assume the best of others. That is the kind of guy he was.
The New York Magazine article is infuriating because it draws absolutely the wrong conclusion about what to do about all the uninsured 20-somethings out there.
Wrong. In those states there's still a third of U.S. healthcare dollars not going to healthcare, but instead to duplicated administration, obscene CEO salaries, profits, and marketing. People in those states still pay, per capita, twice as much for healthcare as do people in other countries, and there are just as many left uninsured or with crappy insurance packages. I haven't googled "Tonik," but would bet that it's a junk policy, with a high deductible, lots of co-payments, and a fat premium increase if it turns out you have anything wrong with you. In other words, if you might need care.
It was a painful article to read, as it opened and closed with the story of Andrew Ondrejcak's bout with appendicitis. He survived.
Paul should have survived too. Would have, if there hadn't been an entire series of screw-ups and wrong judgments at the hospital.
"We trusted them," Sarah told me afterwards. "We trusted them."
Paul had evidently been on some kind of campaign to convince her to be more trusting of people — to assume the best of others. That is the kind of guy he was.
The New York Magazine article is infuriating because it draws absolutely the wrong conclusion about what to do about all the uninsured 20-somethings out there.
The common assumption is that the exorbitant rates are schemed up by the politically influential executives governing the trillion-dollar insurance industry. But if insurers could target cheaper plans at younger New Yorkers, they would: Every business thrives by exploiting untapped markets. State law, however, requires insurers to follow a “community rating” system that throws everyone—young, old, sick, healthy—into one risk pool. “The whole point of insurance is that you’re pooling the risk to spread out the costs for everyone,” explains Cunningham. “If you target healthier groups with favorable policies, you’re likely going to make it more expensive for the older, less-healthy populations who need regular care.” Of course, if the young and healthy don’t buy policies at all, who’s balancing the costs? Recognizing this Catch-22, some states have adopted a more flexible “age banding” system, allowing insurers to customize packages based on age. WellPoint recently created a youth-centric program called Tonik, with plans as low as $67 a month, but it’s currently only available in eight states.So things are fine in those eight states.
Wrong. In those states there's still a third of U.S. healthcare dollars not going to healthcare, but instead to duplicated administration, obscene CEO salaries, profits, and marketing. People in those states still pay, per capita, twice as much for healthcare as do people in other countries, and there are just as many left uninsured or with crappy insurance packages. I haven't googled "Tonik," but would bet that it's a junk policy, with a high deductible, lots of co-payments, and a fat premium increase if it turns out you have anything wrong with you. In other words, if you might need care.
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