30 January 2008

Come to the Rally Tomorrow!

California Mandate Plan Goes Down

It was good news regarding ABX1 going down in California. Here's from the LA Times:
Senators said it was too risky a financial commitment when California faces a $14.5-billion budget gap that could force them to cut existing healthcare programs. Schwarzenegger has proposed $2.9 billion in healthcare cuts over the next 18 months.

"It doesn't matter if there are these good things in the bill if there isn't the money to pay for them," said Sen. Sheila Kuehl (D-Santa Monica), who chairs the health panel and has proposed that the state take over the role of providing medical insurance. "We can't simply say to the people of California, 'Go buy insurance.' "

The defeat may be a poor omen for national efforts to overhaul the country's healthcare system. The three leading Democratic presidential candidates -- Hillary Clinton, Barack Obama and John Edwards -- all have proposed similar programs aimed at expanding private insurance while allowing people who have coverage they like to keep it.
The NYT also had a story on this, with this great quote:
“I just came to the conclusion that the working people are going to end up paying for it,” said Senator Leland Yee, Democrat of San Francisco, who announced his opposition before a committee meeting last Wednesday. “There’s control for everybody else — the employers are protected and the insurance industry. The only group that’s vulnerable is the working people.”
I understand that good people believe that mandates can work. Good, smart people, in fact, who've been at this far longer than I have. But that's part of the problem. These good folks are still shell shocked from the last battle. We can't fight the last war. Conditions are different now. More people have been hurt, the insurance industry has very little credibility. It may well be that we have to do this incrementally. But forcing people to buy private health insurance policies from for-profit companies is a deal killer.

Sick & tired

I'm so sick. And the rally is tomorrow.


28 January 2008

More Unions for Single-Payer

Kay Tillow of Unions for Single-Payer HR676 has an inspiring steadiness of purpose. She's like Elinor Christiansen, MD, of Health Care for All Colorado in that she's been at this for decades. Most of us would throw our hands up at some point, buy a sailboat and head for Bali. Enough!

Not Kay or Elinor.

I get Kay's email blasts a couple times a week -- about big news, like the Executive Council of the California AFL-CIO unanimously endorsing HR 676, (With 2.1 million plus members the CA Federation is the largest state affiliate of the AFL-CIO.)

California was the thirty-second state to endorse HR676 -- Alabama was the 31st a couple weeks ago.

Kay also emails about local steps, like these endorsers of HR676:
  • In Charleston, SC, Local 502, Coastal Carolina Association of Professional Musicians voted to endorse HR676,
  • In El Segundo, CA, the Executive Board of Transport Workers Union Local 564 voted to endorse HR676,
  • In Louisville, KY, the National Association of Letter Carriers (NALC) voted to endorse, and
  • In San Francisco, CA, the Sailors’ Union of the Pacific voted to endorse.

HR 676 would bring universal health care to the U.S. through a single-payer financing mechanism, a bit like a greatly improved Medicare for all.

It would cover all necessary medical care, including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for
substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. It would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

HR 676 currently has 87 co-sponsors in addition to Conyers.

Rally at the Capitol, Thursday!

25 January 2008

Faculty Unions Endorse Single-Payer

Unions for Single-Payer reports that college faculty unions in three states have endorsed HR 676, the legislation that would institute a single payer system in the U.S. introduced by Congressman John Conyers (D-MI).

In Anchorage, Alaska, the Representative Assembly of Local 4996, United Academics-AAUP/AFT, endorsed HR 676. The local represents 950 faculty members on the three major campuses of the University of Alaska system. In New York, Local 3998, Long Island University Faculty Federation, NYSUT/AFT, has endorsed HR 676. In Philadelphia, AFT Local 2026 endorsed HR 676. Local 2026 represents 1,300 faculty and staff at the Community College of Philadelphia.

How Many Support Single-Payer?

Do pundits and politicians misstate the facts or lie about single-payer and the U.S. healthcare system? Is it because they're uninformed or because they figure they can get away with it?

Steven Maviglio writes about "Single-Payer Dreamland" that "single payer polls in either single digits or low double-digits when Californians are asked what type of health care system they want. Its proponents are vocal, yet few."

Does he also think there were WMDs in Baghdad and that global warming, if it exists, is caused by sunspots?

A number of polls show something quite different than such low support both nationally and in California. Here's a national one by Gallup.

It showed that in November 2007, 41 percent of Americans were in favor of "replacing the current health care system with a new government run health care system," and 48 percent favored "maintaining the current system based mostly on private health insurance." 11 percent weren't sure.

In 2006, it was 39 percent wanting a government system; in 2005, 41 percent; in 2004, just 32 percent; in 2003, 38 percent; in 2001, 33 percent. Those wanting to retain our current for-profit system have declined from 61 percent to 48 percent, with "don't know" rising from 6 percent to 11 percent.

The bigger changes came not between 2001 and today, but rather between 1987. In 1987, answering the open-ended question of what was "the most urgent health problem facing this country at the present time?" only 1 percent said costs. (68 percent said AIDS/HIV.) Today 26 percent say costs. Then, nobody mentioned access as a problem. In the November 2007 poll, 30 percent came up with access.

A number of other resources as well show it's either uninformed or dishonest to suggest only a tiny minority of Americans support single-payer.

Tommy Douglas & Mouseland

The clip is Prairie Giant: Tommy Douglas.

Here's the allegory, which he told for audiences from the 1940s to the 1960s. We need to begin sharing it too:
Mouseland was a place where all the little mice lived and played, were born and died. And they lived much the same as you and I do.

They even had a Parliament. And every four years they had an election. Used to walk to the polls and cast their ballots. Some of them even got a ride to the polls. And got a ride for the next four years afterwards too. Just like you and me. And every time on election day all the little mice used to go to the ballot box and they used to elect a government. A government made up of big, fat, black cats.

Now if you think it strange that mice should elect a government made up of cats, you just look at the history of Canada for last 90 years and maybe you'll see that they weren't any stupider than we are.

Now I'm not saying anything against the cats. They were nice fellows. They conducted their government with dignity. They passed good laws--that is, laws that were good for cats. But the laws that were good for cats weren't very good for mice. One of the laws said that mouse holes had to be big enough so a cat could get his paw in. Another law said that mice could only travel at certain speeds--so that a cat could get his breakfast without too much effort.

All the laws were good laws. For cats. But, oh, they were hard on the mice. And life was getting harder and harder. And when the mice couldn't put up with it any more, they decided something had to be done about it. So they went en masse to the polls. They voted the black cats out. They put in the white cats.

Now the white cats had put up a terrific campaign. They said: "All that Mouseland needs is more vision." They said:"The trouble with Mouseland is those round mouse holes we got. If you put us in we'll establish square mouse holes." And they did. And the square mouseholes were twice as big as the round mouse holes, and now the cat could get both his paws in. And life was tougher than ever. And when they couldn't take that anymore, they voted the white cats out and put the black ones in again. Then they went back to the white cats. Then to the black cats. They even tried half black cats and half white cats. And they called that coalition. They even got one government made up of cats with spots on them: they were cats that tried to make a noise like a mouse but ate like a cat.

You see, my friends, the trouble wasn't with the color of the cat. The trouble was that they were cats. And because they were cats, they naturally looked after cats instead of mice.

Presently there came along one little mouse who had an idea. My friends, watch out for the little fellow with an idea. And he said to the other mice, "Look fellows, why do we keep on electing a government made up of cats? Why don't we elect a government made up of mice?" "Oh," they said, "he's a Bolshevik. Lock him up!"

So they put him in jail.

But I want to remind you: that you can lock up a mouse or a man but you can't lock up an idea.
You can hear hear Tommy Douglas himself tell the story from this 1961 clip at the CBC Archives. It's a story that needs to be told again, and again, and again. In 1944, 1961, 1982, 2000 and today. Because, sadly enough, most mice go through an astonishing transformation when they get rich and powerful. They become cats.

24 January 2008

Edwards OK with single-payer

You'll like the article in the NYT on Edwards:
PATRICK, S.C. — Former Senator John Edwards does not discount the possibility that his health care proposal, which would allow Americans to buy new government insurance packages modeled on Medicare, could evolve into a federalized system like those in Canada and many European countries. And if it does, Mr. Edwards said he would be just fine with that.

But Mr. Edwards, of North Carolina, emphasized in a 40-minute interview on health policy that the choice would be made not in Washington, but by consumers in an open marketplace where private insurance competes with government plans.

Republican candidates and policy strategists have raised the specter of “socialized medicine” and depicted the Democratic plans as a back-door route to a so-called single-payer government system.

Mr. Edwards brushed off that critique. “There is nothing back-door about it,” he said. “It’s right through the front door. We’re going to let America decide what health care system works for them.”

Daily Kos on Obama & single-payer

There's a wonderful essay by a serious healthcare reformer, a professor of Health Policy; Director, Center for Health and Public Policy Studies, UC Berkeley. She writes about Barack Obama and Hillary Clinton (and Hillary's nasty clip accusing Barack of lying about single-payer):
Both of these candidates are very smart people. They both understand that single payer is THE best system for affordable, comprehensive, equitable, secure, efficient health care for all Americans. This is good news.

But the realities of our current system and how it has evolved over time, make it difficult, if not impossible, to move from where we are now to 100% single payer system over night.

I actually proposed this idea of giving Americans the choice of a single payer plan that competes along side the existing system in 2002. I first developed the idea for the state of California as part of the State's HRSA grant for Health Care Options. I will provide links below to both the original proposal as it was developed for California and the a link to the ESRI report (funded by RWJ) on Covering America, which includes the federal model I developed for CHOICE as a plan that would voluntarily transition the entire US health cares system to a single payer system, with private plan options for those who do not want single payer.
Interesting. Here's the link to her site about CHOICE OPTION for California and her federal plan as well -- about which she writes,
The federal plan speaks specifically to the point of having a single payer plan compete with the existing system and allow people to choose which they want. And guess what? Our current inefficient, inequitable, ineffective system cannot compete with a single payer plan. The Lewin Group, using their Health Benefits Simulation Model, modeled the CHOICE proposal and found that within one year of adoption a plan with the option of single payer, 70% of Californians would chose to enroll in the single payer plan and 94.4% of the Californians have health insurance coverage, all without a mandate.

For the sake of the health of the American people let's agree to agree. The goal of health care reform for the Democrats is universal coverage and they all support a plan that will enable the US to voluntarily transition to a single payer system.

Come to the Thursday Rally!

Gooz on mandates

From Merrill Goozner's Gooznews: on forcing people to buy private insurance:
... according to the Boston Globe's Health Blog, the intellectual architect of the Mass plan, Jon Gruber of the Massachusetts Institute of Technology, is admitting that a mandate can only work if there are sharp penalties attached to it since many low- and moderate-income households, even with subsidies, can't afford health insurance on their own. It's also likely that some young, healthy workers will skip buying insurance if they can get away with it. "The mandate has to be enforced," he told the paper. “We need to think beyond what looks mean and do what’s right.”

This is a prescription for dooming any national effort for universal coverage. We're going to impose heavy penalties on people who are already having a hard time paying their bills? Don't forget that the bare bones plans they will buy to meet the minimal insurance standards will probably have high co-pays and deductibles. From the perspective of a moderate-income person whose employer doesn't provide health insurance and who doesn't qualify for subsidies, this will cost them more money for the same care they now receive (emergency room care). The only difference is that they won't have the bill collector hounding them (or the hospital forgiving the bill) after they receive care. What kind of plan is that?
I've heard that before -- "This mandate has to be enforced. We need to think beyond what looks mean and do what's right."

Wasn't that Pol Pot's motto?

Slippery slope.

(Whoops. Did that look mean?)

Buying into Medicare

This LA Times analysis looks at the Democratic Presidential 3 and their agreement that we should be able to buy into a government plan.
The government now guarantees access to healthcare only for seniors and the disabled through Medicare and for the poor mainly through Medicaid. Under the proposals being advanced by Clinton, Obama and Edwards, the government would offer coverage for middle-class workers and their families, with benefits comparable to those now provided for federal employees and members of Congress.

Participation in the government plan would be voluntary, but the approach sparks widely differing reactions.

Mark McClellan, the former Medicare administrator in the Bush administration, called it a risky departure from the state-based changes that the Democratic candidates have cited as their models.

"Of all the states that are considering [reforms], none have set up a public plan to compete with private plans," McClellan, now with the Brookings Institution public-policy center, noted. "It could end up being a back door to single-payer," he added, referring to a government-run system such as Canada's.

What McClellan and other critics say they fear is that the government plan could underbid private insurers and, if large numbers of people sign up, it could eventually replace private coverage, including the employer-sponsored plans that now serve most middle-class Americans.

Some also fear that the government program would become a dumping ground for the most seriously ill -- and expensive -- patients as private companies cherry-picked those least likely to file large claims. If that happened, the federal program's cost would soar.

Despite these concerns, other experts say that giving people the option of joining a government plan might make for a sensible experiment.

"It could be a really fair way to test the market, both in terms of people's preferences and to see what kind of plan can be more successful over time," said health economist Marilyn Moon, a Medicare and Social Security trustee during the Clinton administration.

For example, Moon suggested that a government plan could be used to test ideas for reducing waste and improving quality, such as cutting payments for treatments of dubious value and rewarding hospitals and doctors that document improved results in patient care.

"You could allow a government option as a way of setting a standard, as opposed to issuing lots of regulations that would apply to every insurer," she said.

Republican presidential candidates also have healthcare plans, but -- in keeping with conservative principles -- they rely on market forces, economic incentives and the private sector to increase access to medical insurance and to try to rein in costs. None favors creation of a government alternative to private programs.

GOP opposition is not the only political obstacle to the Democratic idea.

The insurance industry, one of the nation's most powerful lobbies, is against it. "It is a move to significantly expand the role of government and move people off private coverage and to public coverage," said Karen Ignagni, president of America's Health Insurance Plans and the industry's top lobbyist in Washington.

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 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.

Sarkisyans: Insurance Is Not Healthcare

The California Nurses report that the Sarkisyans testified yesterday against Gov. Arnold Schwarzenegger's ABX1.1 mandates bill. After their insured, 17-year-old daughter was denied a transplant, it's the Sarkisyans' experience that insurance isn't the same thing as health care.

How many of us must lose loved ones before this murderous industry is stopped?

How many families must become activists before our neighbors see that it could be them next time -- and act upon that understanding?

I've become a skipping dvd on this issue. The idea that forcing people to pay for-profit insurance companies is part of a solution to our health care crisis is like thinking that forcing shopkeepers to pay protection money to the Mafia is a solution to a crime wave. Which is what the health insurance industry is. A legalized crime wave.

Thank you to the Sarkisyans for taking their anger and grief and using it for good. It would be easier, and possibly more mentally healthy, to just forget about it. But how to save other 17-year-olds from the same fate, then? Thank you to the Sarkisyans.

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.
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.

"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."
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?

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."

23 January 2008

Fooled a Couple Times

Remember Bush's push to privatize Social Security?

I didn't either -- but this letter-writer did:

Good letter to ed in Mpls Star Trib yesterday:

“We should be glad that our Social Security money wasn’t in the privatized hands of Citibank, Merrill Lynch and the other financial ‘wizards’ as President Bush had so strongly urged.”

Something that needs to be said repeatedly & loudly.

Donna Smith shares her story

Donna Smith shares her story at Dandelion Salad, a blog that also has a quote from Rabbi Hillel as its motto: "That which is hateful to you do not do to another ... the rest (of the Torah) is all commentary, now go study."

That sounds familiar somehow. I wonder if the health insurance industry has ever heard it. In any case, Donna and her husband Larry Smith were featured in Sicko. They're the bankrupt couple taking refuge in their daughter's storage room after they've lost their house. After working hard all their lives at jobs that offered health benefits. Single-payer supporters in Denver are very, very lucky to have them here, although we don't always know how to 1) best tap into their passion and talents, or 2) properly show them that we appreciate them.

The problem with single-payer advocacy, see, is that there's no money in it. And though Donna and Larry's work over the past year or so to move forward the cause proves that the libertarians and free-marketeers are wrong -- that people in fact are not only motivated by self-interest and profit, at the same time, there is rent to be paid.

I know that while Larry now is covered by Medicare, she is uninsured for the first time in her life. She writes about how it began, for them, at Dandelion Salad:
At the time, our insurance was good, but not great, but it did at least cover the things that he needed to have done. But like many Americans, our premiums started to creep up, and our co-pays and deductibles started to go up, and the coverage started to get worse. So just at the time when his health care needs were growing, our coverage was shrinking, and we were feeling some bad financial pressure from that.
Come on, fellow Americans. We can't all move to Canada, England or France. We need to fix what's wrong with this country. Not for us so much as for our children, grandchildren and on to at least the seventh generation.


Brisbane. What state is that in?

A leading maternal-fetal medicine researcher has inexplicably ended up at the University of Queensland in Brisbane, Australia -- a far piece from where the only possible environment for innovative research exists -- right here in the U.S.

Only our free-for-all, ignore-the-bodies-they're recyclable-anyway market economy nurtures pharmaceutical companies -- with private health insurance footing a good part of the bill and no government negotiations for pharmaceuticals. Ask Rush Limbaugh if you don't believe me.

So this news doesn't make a bit of sense. But here it is anyway: Professor Nicholas Fisk says that the current research and development and business model of the pharmaceutical industry is failing pregnant women, and describes pregnancy as a virtual "pharma-free zone." He analyzed an industry database that tracks drugs under development since 1981 and found only 17 drugs under active development for maternal health. Only one new class of drug has been licensed in the last 20 years -- and that one case did not take place in either the U.S. or Australia.

Professor Fisk's research looks at the pharmaceutical market's "push" mechanisms (funding to encourage investment from universities and companies) and "pull" mechanisms (funding to purchase drugs once they are on the market) have not been effective in the area of maternal health.

Curiouser and curiouser. Haven't we been assured that market mechanisms are what make the U.S. unique in the world? And that they are responsible for most if not all of the pharmaceutical advances of the past decades? A different way is possible?

Professor Fisk says that manufacturers avoid the need of pregnant women because said women are likely to sue them should the drug result in fetal abnormalities, because of the small market size for conditions affecting pregnant women, the limitations of a shareholder model, and a regulatory system that allows endemic off-label use of drugs in pregnancy, discouraging pharmaceutical investment in the long term.

The professor thinks that drugs for pregnant women should instead be developed under a model like the Neglected Diseases Initiative, which does not rely on profit for innovation.

Libertarians and free-market ideologues reading this should not be alarmed. Research has also shown that when we read or hear something that is dissonant with our deeply held ideological beliefs, we throw the facts out the window, not our beliefs. Such readers have already -- already! -- successfully rationalized this tidbit into support for their own beliefs.

22 January 2008

Single-Payer nuts and bolts

It's one thing to see that single-payer makes sense. Kind of like seeing that the marketplace makes sense, for most goods, or that universal education makes sense, or socialized policing.

It's quite another thing to actually research and dream up the specifics of the best possible American single-payer system.

That's why you have people like George Swan, staunch Republican, fiscal and social conservative, who is outraged at the affront to his family and fiscal values embedded in our current system -- which he describes as 3PMP, third party multi-payer.

Regarding ERISA challenges to a single state enacting universal, single-payer health care, George writes:

"I have written many times the obvious decision for insurers from out of state, those "paying higher prices than average due to cost shifting (see Lewin's vivid graphic in his "Healthcare Spending in Colorado" draft at the 208 Commission website).

"If you're an insurer, and it is possible to obtain healthcare in Colorado 30% less than prices in other states, you'd send your beneficiaries to Colorado, wouldn't you? If ERISA policy-holders and 3rd party multi-payers (3PMP) could get single payer rates in Colorado, due to standard pricing practices (whereby everyone knows what services actually cost), they'd realize a 30% windfall savings (varies, depending on area/providers/carrier/etc). 3PMPs could lower their premiums and pocket increased profits. This is why Blue Cross of South Carolina has developed an agreement for beneficiaries to travel overseas for surgery!

This is why you'd levy a 30% surcharge to out of state (and ERISA-protected) carriers. The surcharge would be adjusted by the Board of Directors, based on data, simply to equalize the charges to non-single-payer carriers. You could even develop a marketing strategy to sell surplus capacity, to become a net importer of medical services!"

Health care tourism, right here in a single-payer Colorado. We'd get a jump on other, slower states.

Conflict of Interest at the Docs

A Duluth health system got rid of all their pharmaceutical-supplied mugs, pads, etc., and shipped them to Cameroon. Twenty shopping carts worth. Here's the story.

Why? "The backlash against the cozy relationships between doctors and drug makers gained steam from article in the Journal of the American Medical Association in 2006. It said research had shown that even cheap gifts, such as pens, can affect doctors' prescribing decisions."

(Thanks Eliza. It is a small step..)

What! Innovation in Single-Payer Britain?

Also from Medical News Today, the inexplicable decision to locate a new research center in Manchester. That's Manchester, UK, not Manchester, MA.
MIMIT (Manchester: Integrating Medicine and Innovative Technology) - the first international affiliate of the highly successful [Boston] US centre CIMIT® - will draw together clinicians and scientists from a group of Greater Manchester hospitals, GP practices and the University of Manchester in major collaborations to apply the latest technology to clinical problems and transform healthcare in the UK...

"There are many similarities between the CIMIT® approach to innovation and the organisational components which comprise the bio-medical-engineering research cluster in Manchester," [said CIMIT® founder and Executive Director Dr John Parrish.] "I am looking forward to collaborating with our new colleagues."
Have these people not gotten the word? Single-payer ends innovation. Good grief.

GM offers buyout; new workers will get less

The Detroit News reported Friday that GM is offering an early retirement package to about two-thirds of its work force and suggesting production cut-backs and plant closures. That's 46,000 blue-collar workers, on top of 34,000 since 2006. It would open positions for new employees who will receive lower wages and reduced health benefits.
The bulk of savings from the new, four-year contract won't kick in until 2010. That's when GM expects a key piece of the deal -- a fund that allows GM to pay a reduced rate to turn over $50 billion in retiree health care costs to the union -- will be implemented.

PA Gov Aims To Fund Coverage for Uninsured

There's politicking going on in Pennsylvania as Democratic Gov. Ed Rendell has threatened to fund his plan to offer more affordable health care to nearly 800,000 uninsured adults by tapping into a $400 million state fund that helps doctors pay their malpractice insurance costs.

Time out. There's a state fund for comparatively wealthy physicians to cover the depredations of the insurance industry, but not for the working poor -- for whom it's a matter of life and death? Don't get me wrong, the cost of malpractice insurance is another example of the insurance industry run amok. But the fact that the state stepped in to help the doctors does show the relative strength of concern for physicians vs. for the working class. And how com the Right continues to argue that malpractice costs are part of the reason for high medical costs in the U.S., if there are, evidently, state funds helping out?

Here's a 2005 pdf report that shows that
  • Over the last five years the amount the major medical malpractice insurers have collected in premiums has more than doubled, while their claims payouts have remained essentially flat.
  • Some malpractice insurers substantially increased their premiums while both their claims payments and their projected future claims payments were decreasing.
  • Malpractice insurers accumulated record amounts of surplus over the last three years.
Back to the governor -- a year ago he introduced Cover All Pennsylvanians. The single-payer movement in Pennsylvania was frustrated by that plan, because although Rendell has said he'd sign a single-payer bill if it passed the Legislature, instead he put forward his own plan, which does nothing to rein in costs. Those following the Pennsylvania reform effort call Rendell's bill "No Health Insurance Company Left Behind," and note that "Capital Blue Cross’s CEO, Anita Smith, was standing at Rendell’s side when he introduced his bill." Oddly enough, Pennsylvania lawmakers "showed little interest in helping to fund it with a tax on businesses that did not offer health insurance to workers."
The state's doctors could pay a price if no agreement is reached soon. The governor has declined to approve medical malpractice subsidies, known as abatements, through the state's MCare program until lawmakers agree to fund Cover All Pennsylvanians. If no deal is struck by March 31, the unsubsidized bills will come due.
Furthermore, the governor has pledged to campaign against Republican legislators in the fall, if they continue to balk.

The response seems to be a GOP yawn and shrug.

NC Blue Cross publishes prices

Medical News Today reports that Blue Cross Blue Shield of North Carolina is publishing online (for its members only) the prices it pays for thousands of procedures. Here's some examples:
  • Physician office visits, with separate categories of average costs for a variety of services for men, women and children. For example, the average cost BCBSNC pays statewide for an annual physical examination for a 35-year-old man is $279, including recommended lab work and immunizations. A child's doctor visit for a cold typically costs the company $75.
  • Diagnostic screenings and surgical procedures, with average costs broken out by place of service. For example, an MRI provided in an outpatient hospital setting costs BCBSNC $1,975 on average, while the same scan in a freestanding facility costs $933. Anterior cruciate ligament (ACL) surgery costs the company an average of $10,337 if done in an outpatient hospital setting, and $6,859 if done in an ambulatory surgical center. The average cost for an outpatient colonoscopy is $2,040 at a hospital, $1,203 at an ambulatory surgical center and $889 in a physician's office.
  • Total average costs for treatment of diseases and conditions. For example, the average total that BCBSNC would expect to pay for a member who requires heart bypass surgery is $57,280, including office visits, hospital costs, drugs, tests and other services. A typical course of breast cancer treatment, including surgery, costs $26,749.
  • The Health Cost Estimator includes prices BCBSNC pays for the most commonly used prescription medications. Members can learn, for example, that a brand name cholesterol-lowering drug can cost as much as $150 or more for a month's supply, while a generic drug can cost as low as $20 per month.

21 January 2008

Close to Home cartoon

Massachusetts' plan no gain

Take a look at "An Uninsured Kick in the Groin in today's Boston Globe. Alison Bass writes:
THE NEARLY 300,000 Massachusetts residents who signed up for health insurance under the state's new initiative are in for a rude awakening. They may now have some form of coverage, but many of them, even the very poor who used to get free care, are going to be socked with steep medical bills.

Welcome to the shadowy world of underinsurance, where high premiums, copays, deductibles, unexpected co-insurance charges, and skimpy coverage have put the lie to the dream of health coverage for millions of Americans. According to a 2005 Kaiser Foundation study, more than 58 million Americans already find themselves in this category: underinsured and at high risk of incurring punishing medical bills. My family is among them.

Insurance's goal: products & participation

This is telling:
Q: Indiana has roughly 750,000 people who are uninsured. As the state's largest commercial health insurer, does Anthem share in the blame for the large number of people who find health coverage unaffordable and unattainable?
A: I don't think there's any single payer that's to blame. We're all operating in the system that we're operating in, which is the private payer system, which is an employer-based system. No employer is required to offer health insurance, nor is any (insurer) required to offer health insurance.
What I do think we have an obligation to do, and it's a challenge, is to try to develop products that are affordable and that provide value to employers and their employees so they want to participate in the private-payer system.
We have an obligation to cooperate whenever we can and however we can with government, like we have cooperated with Gov. Daniels and his Healthy Indiana program.
They have an obligation to:
1. Develop products that are affordable (This isn't health care. It's 'products.') and that
2. Provide value to employers and their employees (Still no health care.)
3. So that they want to participate in the private-payer system. (Still no health care.)

Not so that lives will be saved, families strengthened, etc.

The reason is so that employers and employees will want to participate in the private payer system. As if there's a choice.

Canada's "failed" system

The issue of Canada's "failed" system is a bit like the lawyer's question, "When did you stop beating your wife?"

If you bring up data that shows that Canada's system is actually in better shape than ours -- at about half the cost -- it implies that you are advocating for a Canada-like system, when in fact single-insurer supporters in the United States believe that we could actually do far better than Canada.

But you have to reply. It's a given in too many Americans' heads that Canada's is a failed system -- just like it's a given that Barack Obama is a "dangerous Muslim." They heard it on that great pipeline of lies, talk radio.

Anyway, here's a listener writing the Fort Collins paper, the Coloradoan:
Colorado is moving toward a single-payer health-care system that it is going to model after the one in Canada... If we do allow these people in Denver to emulate this failed system, we must at least be certain that they do not take away our right to also have access to private insurance and hospitalization at our own cost to make sure that what is happening to so many in Canada will not befall us here as well."
Although he's wrong about Canada, I have to hope he's right about our moving towards single-payer. It's fear-based prediction on his part, pure hope on mine.

There was a longer piece along these same lines yesterday in the Sea Coast Online, from the author of "Doggone Right."

He was writing to counter opinion pieces written by two physicians and a nurse, all calling for single-payer. He dismissed them, saying that their medical degrees weren't degrees in economics. He writes that he and his wife understand "recognize that I am alive and kicking because of the quality of care we purchase."

This is at the root of a lot of the Right's opposition to universal health care. They don't just have the anti-government ideology, although that's part of it. They want people to suffer if they don't work hard enough. They want the system to reward the good and punish, really punish, people who don't measure up. The fact that the system is stacked against a lot of folks doesn't matter for many, and for the rest, it's just a matter of tweaking, and private charity should take care of it.

This Portsmouth guy rails a bit against "free" health care -- which, of course, is a straw man. One of the MDs wrote about the Massachusetts plan: ""Seventy-nine percent of these newly insured individuals are very poor people enrolled in Medicaid or similar free plans. Virtually all of them were previously eligible for completely free care funded by the state, but face co-payments under the new plan."

The point of this is that Massachusetts has held up as a point of success the numbers of people who have signed on to insurance since the mandate went into effect. In fact, the people who have signed on are not people who would have to pay much, if anything, out of their own pockets. The problem Massachusetts has run into are lower wage families who would have to buy out of their own pockets one of the crappy plans offered to them.

In what is almost surely a deliberate distortion, the Portsmouth guy says that because the physicians called this care "free" they don't know what they're talking about. "There is no such animal as free health care. You and I pay every penny, through taxes and our own insurance premiums."

The guy's a regular Sherlock Holmes. Glad he cleared that up for us.

Jonik on the corporate web

John Jonik is a whole systems thinker. He's also a very good cartoonist. Turns out he can write as well.

We don't often think about the wider web around health insurance -- how it links to other industries and may even explain some of corporate America's allegiance to health insurance even though it demonstrably hurts their ability to compete globally.

We hope instead that business will decide that health insurance is "the weakest link" and fire it the same way Trump would do.

In "Private Insurance Is Bad for Your Health," Jonik suggests that the safety net for this inept and heartless industry may be stronger than we think.
Private insurers are invariably investors, with what was our health care money, in all sorts of industries, many of them being notorious for causing health problems.

We know, from SEC (Securities & Exchange Commission) material, that top insurers have been or still are multi million dollar investors in cigarette manufacturing! They may also invest in tobacco pesticides and even the firms that supply carcinogenic radioactive (!) fertilizers to tobacco growers...not to mention chlorine interests that are responsible for presence of dioxin in the smoke from adulterated products, agricultural firms that supply pesticide-contaminated crop ingredients, paper/pulp, sugar, burn accelerants, and flavorings/sweeteners/aromas etc from pharmaceutical firms.
It's a good point. Jonik concludes, "The United States public is capable of taking care of its own health system, as citizens of other countries manage quite well, without the questionable 'help'...thanks anyway...from unnecessary, parasitic private insurers."


20 January 2008

Best Bushenomics article ever

Larry Beinhart's article on Bushenomics at Alternet is well worth a read. Some of his points regarding the looting of our country that's taken place under Bush:
  • With privatization, one dollar out of every three for direct military operations in Iraq and Afghanistan goes to private contractors like Halliburton and Blackwater.
  • Most the assets of the United States, our collective wealth, could not be sold off in such a direct manner. The administration instead borrowed against them. They cut taxes while continuing to spend lavishly, creating debt. The debt is owed by all of us, the people of the United States.
  • As measured by the GDP, the economy grew by 35 percent between 2001 and 2007.
  • Job creation: In the first six years of the Clinton administration, 13.7 million jobs were created. In the same period, under Bush, only 3.7 million jobs were created. Barely keeping up with population growth.
  • Median income: That's as opposed to average income (If Bill Gates walks into a bar with 10 people, the average income of everyone in the room goes up by $17,5000,000. But the median income just moves up half a notch, from between the fifth and sixth person, to the sixth person's income). From 2001 to 2005, median income, for people under 65, went down $2,000.
  • America's businesses: Under Clinton, the Dow Jones went up 324 percent. Bush arrived in 2001. Since then the Dow Jones is up just 10 percent.
  • So where is that 35 percent growth in the economy?
  • The M3 took off like a rocket after 2001. The Fed stopped publishing the M3 in 2006. (The M1 is basically cash, plus checking and "current" accounts. The M2 adds savings accounts, money market accounts and CDs up to $100,000. The M3 adds in the big CDs, Eurodollar accounts and other large exotics.)
  • The administration grew the economy (or at least the amount of money in circulation), without inflation... If [Bushenomics] had created business growth -- actual business, not just financial business -- that would have created jobs. Then there would have been inflationary pressure. If salaries for ordinary people go up, even a little, the total is a big sum. But due to free trade, outsourcing, bad economic policy, policies aimed at keeping wages down, and relentless union busting, good jobs were lost, to be replaced with low-wage jobs, when they were replaced at all.
  • Finally, the Fed kept interest rates down. The supply of money was increased. The price of money was kept artificially low.
  • With no new boom to invest in, businesses made loans.
  • The loans grew into a bubble...
  • No job growth, no business growth, no stock market growth, falling median incomes, disappearing pensions and health plans, and the fall of the dollar.
  • The real solutions are pretty obvious and pretty simple. First, we have to make a choice: Do we want a sound economy for all of us and a strong America? Or do we want to have a few people of unlimited wealth who use that wealth, among other things, to control the government so that it helps them milk more money from the rest of us?
  • In the real world, there are no such things as free markets. In the real world, business people manipulate and conspire to control markets, and governments both control and collude with business, while tax policies and government spending have a major affect on the economy.
  • Simply giving money to rich people doesn't work. Bob Novak, the conservative commentator who calls the investor class "the most creative class," is flat out wrong.
  • Money has no mind of its own. It has to be directed toward areas that will generate and support business and good jobs at good wages. As it happens, our economic goals are on the same road as the social good.
  • The No. 1 target has to be alternative energy.
  • The No. 2 target is infrastructure.
  • The No. 3 target is health care.
  • The No. 4 four target is a balanced budget.
  • How can all this be done? Raising taxes. On the wealthy. And on corporations. That's not class warfare. That's simple practicality.

19 January 2008

Paul does Karaoke

Big pool in New Mexico

The New Mexico Business Weekly may have finally gotten a better term than single-payer through my thick skull.


That's pretty clear, isn't it? Not so threatening?

The NM Business Weekly's article, "Little-known Health Security Act could make a splash thanks to two studies," explains the difference between Gov. Bill Richardson's compromised and designed to fail "health solutions act" and the real deal, the "Health Security Act":
The most profound difference in the plans lies in the role of private insurers. They would maintain and, presumably, expand their current roles under the Health Solutions plan, while the Health Security Act would relegate them to providing supplemental insurance.

In place of private insurance, Health Security would create a single insurer (supporters don't like the term "single payer") to cover all 1.6 million New Mexicans who are not federal government retirees, active and retired military or tribe members (who could opt in). The single big pool, supporters say, would mean lower insurance costs overall than the dozens of separate insurance pools that exist today.

Where's the single-payer coverage?

The Rocky Mountain News' media critic, Jasan Salzman, has a good question in his column today. He asks why reporters aren't asking Colorado politicians, in particular Governor Bill Ritter, about Health Care for All Colorado's single-payer plan for Colorado health care. Salzman writes that both the News and the Denver Post "have reported that Gov. Bill Ritter is worried about the expense of his goal of providing health care to all Coloradans, regardless of which plan is chosen.

"Reporters should challenge this notion by noting that the governor's own Blue Ribbon Commission for Health Care Reform states that a single-payer system would actually reduce total state health-care expenditures by $2 billion. But it would require, according to the commission's report, an 8 percent income tax increase. Our political leaders should be asked whether the real issue is cost or political will."

Governor Ritter answered that question when I posed it to him at the Faith in Action Conference last weekend. Answered it to my satisfaction, in fact. He said that he was in favor of universal health care, but that it shouldn't come to a vote until it can win.

In some ways, we're at the same stage in this issue as we were back in the 1960s with cigarettes. Lots of educating needs to take place.

But for that education to take place, the reporters do need to pay attention, and ask the questions.

San Franciscans covered for now

USA Today's headline reads "Businesses fight plans to ensure health care" -- the worst possible head for advancing health care.

That's because the polls show that small business is the key icon for Americans, held in higher esteem even than moms and apple pie. If small business is against it, so is America.

But consider this. It's true that a couple San Francisco businesses sued so they wouldn't have to pay more for health insurance for their employees -- and a lower court agreed with them, that the Employees Retirement Insurance Security Act forbade the state to require employers to insure their employees. But there's always going to be some businesses against minimum wage, health insurance, child labor laws, whatever.
At issue in the restaurant association's lawsuit is a 1974 federal law, the Employee Retirement Income and Security Act. It bars states from requiring employers to offer health insurance or regulating the benefits they do offer to protect companies from varying laws. Congress gave only one state, Hawaii, an exemption from the law in 1975. It is the only state that requires employers to provide health insurance.

Last week, a three-judge panel of the 9th U.S. Circuit Court of Appeals said business owners such as Scherotter will have to comply with the law, at least until the full court can review the lawsuit later this year. A lower court sided with business owners.
More important were the poll last year that showed that California businesses are in favor of universal health care:"Despite High Cost, Small Business Says It Supports Universal Health Care -- 80 Percent Say Employees Deserve Health Coverage" from the San Diego Business Journal:
About 500 small businesses across the state were randomly surveyed by phone and e-mail; many were in support of a 1 cent sales tax solution, while favor for a single-payer system was split, with the majority of business owners who don’t provide health care voting for the single-payer system, according to survey results.
Another article, this one from the Sacramento Bee covered that same poll. Some key findings:
  • 57% regard health care financing as a shared responsibility among individuals, employers and government – three times as many as do not (19%).
  • 55% were in favor of paying into a statewide pool that would enable their employees to obtain coverage at favorable rates – over three times greater than those opposed (17%).
  • A substantial plurality (near-majority) said that they favored two leading California healthcare reform proposals, with a small plurality supporting a single-payer plan:
  • Governor’s proposal -- 47% in favor; 31% opposed
  • AB 8 (legislative leaders’ proposal) -- 47% in favor; 33% opposed
  • SB 840 (single-payer) -- 42% in favor; 40% opposed

Save the NHS

There will always be a battle on the part of private profiteers to take over services they see could turn a dollar. Globally, there was a fierce war over privatizing water during the 1990s. Maybe that one has ebbed for a while. For-profit health insurance, which is a proven money-maker (and killer), is like a parasitic invader around the world, even in places where the public good has seemingly won out. Like Great Britain.

Keep Our NHS Public is a group publicizing the fact that "vital services and precious NHS resources are being handed over to the private sector, including companies run for profit for shareholders here and overseas." The group was launched in September 2005, and, like the single-payer movement in the United States looks to be led by doctors, academics, health workers and trade union leaders.

Tony Blair forced the group to mobilize, because of market reforms he'd pushed. Gordon Brown recently committed to keep on track with Blair's misguided efforts.

Lord Darzi, Brown's health minister, has put forth an interim report on the NHS -- which has been analyzed in turn by the Keep Our NHS Public group. They found Darzi's use of evidence is weak, and without any evaluation of the impact of markets on the NHS so far.

NHS staff and patients are calling for a moratorium on market reforms.

18 January 2008

Unfavorable drug tests buried or changed

Hard to believe, isn't it? And yet Reuters reports that an Oregon Health Sciences University study shows that nearly a third of anti-depressant drug students are never published. Evidently because they showed the drug was ineffective.

Perhaps it's just a coincidence that most of the unpublished studies show that the drug being tested didn't work. It could be information that your physician didn't need to know anyway. We all know that a positive attitude can work wonders.
Of the 74 studies that started for the 12 antidepressants, 38 produced positive results for the drug. All but one of those studies were published.

However, only three of the 36 studies with negative or questionable results, as assessed by the FDA, were published and another 11 were written as if the drug had worked.
Wait a minute. Rewritten as if the study showed success?

To name names:
  • GlaxoSmithKline's Paxil -- 7 negative studies; 5 never published
  • GlaxoSmithKline's Wellbutrin SR -- 3 studies, 2 of them negative, neither ever published
  • Pfizer's Zoloft -- 5 studies, 3 of them negative and never published; a 4th, questionable one (in the FDA's opinion) written and published with the inference that the drug worked

17 January 2008


Health care: a shared responsibility

Reponsibility without authority in your work is the worst of all worlds. In health care too -- and yet that's exactly where we are right now. No wonder we're so stressed. The guys with the authority, the health insurance companies, have but little responsibility. Their responsibility is to their shareholders, and they're doing just fine in that department, thank you very much. Individuals, on the other hand, are told time and again that it's up to us to find that job with good benefits, to exercise and eat healthily (amidst all the conflicting advice from experts -- wine or no wine? Coffee or no coffee? Fish or not too much fish? Vitamin C helps with colds or doesn't it?), to understand insurance policies that even lawyers can't make heads or tails of (that's the point), to hire advocates to look out for our interests with providers and insurers (or to tell our insurer that we're close personal friends with Michael Moore) -- and so on.

The public knows we need reform, but what kind of reform? That scary single-payer? Mandates forcing everyone to buy insurance from the same people who seem to be at the root of the problem? Expanding access to SCHIP? Insurance market reform? HSAs? The Commonwealth Fund released a survey of Americans' views earlier this week. Ezra Klein and the media largely picked up on the question that showed 68 percent of Americans favoring mandates forcing individuals to buy private insurance (with the government helping those who are unable to afford it).

There's more to the survey, however, beginning with the fact that support for mandates included soft support:

There is stronger agreement that financing for health insurance coverage for all Americans should either be paid mostly by the government or else be a responsibility shared by employers, government, and individuals:

Most single-payer supporters, by the way, would probably answer that question along with the majority -- that costs should be shared by employers, the government, and individuals -- as is true in most countries with guaranteed health care. Personal responsibility is an important part of the single-payer message.

Note that the portion believing that the government should "mostly" pay for health care costs is 15 percent of the total, versus 6 percent who think those costs should be "mostly" paid by individuals.

One more chart from Commonwealth Fund -- which is a treasure trove of charts in powerpoint and pdfs formats. This one shows the percentage of Americans who think there should be a business mandate:

Quite a bit higher than the numbers in favor of an individual mandate. When single-payer groups around the country have written single-payer bills and proposals (like the one modeled here in Colorado), they typically discover what we did -- that to pay for the program it's necessary to collect contributions (a tax, premium, whatever you want to call it) not only from individuals but also from businesses.

The business task force to the Colorado Blue Commission for Health Care Reform told commissioners that they could live with a 4 to 6 percent tax in order to fund health care. That would be far more affordable than the average of 10 to 12 percent they now pay -- and the quotes of 25 percent that smaller businesses with older employees regretfully decline, leaving their employees uninsured. The task force told the commission that they'd been surprised to learn the truth about single-payer during their meetings, and that members had said they could indeed support a single-payer plan. They just thought it needed to happen at a national level rather than a state level -- something with which HCAC disagrees.

Back to what kind of reform is needed. Health care is a devilishly complicated subject, encompassing many variables. It's no wonder that most people hope that the experts will hand us a solution, no wonder that folks are misled by ideologues and obscenely wealthy special interests. But consider this. At the National Congress for the Un- and Underinsured last month there was exactly one speaker among dozens who unambiguously called for single-payer. David Himmelstein, MD, told the crowd of health policy professionals and academics that single-payer financing for health care is the only sustainable, workable solution that will give Americans the kind of quality health care we want.

There was also exactly one standing ovation at this entire conference of health care policy wonks.

It was for Dr. Himmelstein.

J. Jonik on the insurance industry...

Would that be called a conflict of interest?

250 Mass docs call for single-payer

The California Nurses report that Doctors Give Massachusetts Health Reform a Failing Grade - Poor Early Outcomes Raise Red Flags, Only Private Insurers Profit.

You don't say.
Starting January 1, 2008 Massachusetts residents face fines if they cannot offer proof of insurance. Yet as of December 1, 2007 only 37% of the 657,000 uninsured had gained coverage under the new program. These individuals often feel well served by the reform in that they now have health insurance. However, 79% of these newly insured individuals are very poor people enrolled in Medicaid or similar free plans. Virtually all of them were previously eligible for completely free care funded by the state, but face co-payments under the new plan. In effect, public funds for care of the poor that previously flowed directly to hospitals and clinics now flow through insurers with their higher administrative costs.

Among the near poor uninsured (who are eligible for partial premium subsidies) only 16% had enrolled in the new coverage. And barely 7% of the uninsured individuals with incomes too high to qualify for subsidies had enrolled according to the official state figures. Few can afford premiums for even the skimpiest coverage; the lowest cost plan offered for a couple in their fifties costs $8,200 annually, and carries a $2,000 per person deductible.

Moreover, the state's cost for subsidies is running $147 million over the $472 million budgeted for fiscal year 2007. Meanwhile, collections from fines on employers who fail to provide coverage are 80% below the original projections. The funding gap will widen in future years as health care costs escalate and insurers raise premiums. Already, state officials speak of making up the shortfall by forcing patients to pay sharply higher co-pays and deductibles, and by slashing funds promised to safety net hospitals.

While patients, the state and safety net providers struggle, private insurers have prospered under the new law, and the costs of bureaucracy have risen. Blue Cross, the state's largest insurer, is reaping a surplus of more than $1 million each day, and awarded its chairman a $16.4 million retirement bonus even as he continues to draw a $3 million salary. All of the major insurers in our state continue to charge overhead costs five times higher than Medicare and eleven-fold higher than Canada's single payer system.

Missouri plan won't work

A Families USA report has found that Missouri Governor Blount's health care reform proposal is a piecemeal plan that addresses only a portion of the individuals who lost coverage when he dramatically cut Medicaid several years ago. It wouldn't do a good job covering the 700,000 Missourians who are uninsured.
  • Eligibility criteria exclude many low-income adults, including people who were once covered under Medicaid.

  • Coverage offered is missing key benefits.

  • Cost-sharing is too high for many low-income people.

  • Shaky financing may do more harm than good.

The background information is that in 2005, Governor Blount cut the state's Medicaid program, resulting in upwards of 100,000 Missourians losing their coverage -- and more than 300,000 seeing their benefits sharply reduced. These cuts were some of the largest by any state in the history of the Medicaid program.

Low-income parents were the hardest hit. About 68,000 lost coverage. Missouri became the 41st state ranked in terms of working parents' eligibility for Medicaid.

This is part of the problem with health care being a charity rather than considered part of a government's legitimate protective functions.

16 January 2008

Paul on Mt. Whitney

Liver transplant outcomes better in UK

Maggie Mahar, author of one of the best books on our health care mess, Money-Driven Medicine: The Real Reason Health Care Costs So Much, has a good article at her blog on cherry picking numbers to "prove" that the U.S. has best health care in the world.

Mahar researched the numbers behind the Wall Street Journal column on Nataline Sarkisyan, the 17-year-old California girl who died last month after her insurance company refused to pay for a transplant. That column's author referred to an unnamed British medical journal study on survival rates for transplants for people suffering from chronic liver disease and acute liver disease.

Mahar begins her rebuttal by asking whether fact that we perform a greater number of transplants on seriously ill patients is reason to claim that U.S. health care is better — "or does it simply mean that we are more inclined to experiment on our sickest patients?"
It all depends on how well the average patient who is plucked out of the ICU to undergo a liver transplant fares. If he or she goes on to enjoy several years of high quality life, one would be inclined to say “yes”—our more aggressive care equals better care. But if too many patients suffer complications and then die in great pain twelve or 15 months later, it would be much harder to argue that “doing more” makes U.S. healthcare “better”—especially when both the money and the liver could have been spent on another patient who had a better chance of surviving.
She found the study used by the WSJ writer. She writes that indeed it found that patients' five-year mortality after transplants for acute liver failure, the type from which Ms. Sarkisyan presumably suffered, was about 5% higher in the U.K. and Ireland than the U.S. The WSJ author also cherry picked this statistic: "in the period right after surgery, death rates were as much as 27% higher in the U.K. and Ireland than in the U.S., although differences in longer-term outcomes equilibrated once patients survived the first year of their transplant.”

Meaning that by the end of the first year, the differences canceled each other out. Mahar writes:
Begin with how the patients were faring during the first 90 days... during this time, mortality rates in the U.S. were lower (regardless of whether patients had originally suffered from acute or chronic liver diseases.) This is, in large part, the article suggests, due to lower nurse/patient ratios in the U.S. and more intensive care during the first weeks following surgery.

But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.
So in fact, "Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second... "

Americans favor mandates

Ezra Klein reports on a poll finding that 68 percent of Americans agree that "individuals should be required to have medical insurance, with government help for those who cannot afford it."

So 68 percent agree that underinsurance and gouging is the answer?

I don't think so. I think that people just really want this to be someone else's problem. Like -- the uninusured!

Emergency room waits

A Harvard study shows that waiting times in U.S. emergency rooms, especially in urban areas, has doubled since 1997.
For patients ultimately diagnosed with heart attacks, the wait time rose from 8 minutes in 1997 to 20 minutes in 2004. Patients who needed attention within 15 minutes, according to triage nurses who evaluated them, waited 10 minutes in 1997 but 14 minutes in 2004.

In urban hospitals, the emergency room wait was 30 minutes compared with 15 minutes in nonurban locations.

For black patients, the wait took 31 minutes, for Hispanic patients it was 33 minutes, and for white patients it was 24 minutes. Women waited 26 minutes, one minute longer than men. The longer waits for black and Hispanic patients reflect greater crowding at hospitals serving mostly minority patients, the authors said. They did not find evidence of bias in how patients were triaged.

The longer wait times were tracked during a period when hospital emergency departments were being closed even though patient visits were going up, the authors say. Emergency visits climbed 78 percent from 1995 to 2003 but the number of emergency departments fell 12.4 percent from 1995 to 2003.

Fewer emergency departments could be one explanation for the longer wait times, but Wilper also pointed to a lack of beds for seriously ill patients once they are admitted to the hospital. This Globe story explored efforts in Massachusetts to reduce “boarding,” when admitted patients stay in the emergency department, sometimes for 10 or more hours until a regular hospital bed becomes available.

Other drivers of lengthening wait times could be a shortage of specialists on call to see patients in the emergency department and a lack of access to primary care for people who go to the emergency room for non-urgent needs.
It's difficult for most of us to get a handle on this -- hospitals moving to the suburbs, a lack of primary care for and increasing number of people, fewer physicians willing to do hospital work -- and how it all ties in to our asinine system of financing health care.

Mostly it's easier to set sights on those uninsured people, coming to the hospital for non-urgent needs. That needs to be stopped, eh? They should wait until their needs are urgent.

Like Paul did.

Health Insurance to Africa

Sound familiar?
Private insurance products hardly exist for the rural and urban poor and in cases where they do exist they are not affordable for them. Public Social Insurance Services are mostly insufficient and exclude people working in the informal sector. Nine out of ten people in Sub-Sahara Africa therefore do not have any access to health or accident insurance. They have to pay tremendously high fees for treatment, medical care and hospitalisation out of pocket. Especially those people living below the poverty line (more than 40% in Sub-Saharan Africa) have to take out loans, dissolve their savings or sell essential resources to pay for their treatment. Therefore, many are not in the position to make use of the required services at all. In fact, many people fall into poverty due to illness and treatment costs.

For decades now the World Bank and IMF -- a bit like loan sharks in poor neighborhoods -- have held out fat loans for poor countries. The price for accepting those loans was accepting neoliberal ideology, and privatizing public services.

The loans also weren't usually tracked very carefully, so that they became a corrupting influence for government officials who became fat and retired to Switzerland on them.

So government services were cut, including health care. The money was ineffeciently spent, and then the loans came due -- forcing a further cut in social services. Including health.

And now a German professor has a research project going for how "access to proper insurance for all can be reached successfully" -- through micro-insurance. Same as we have here!

All according to plan.

15 January 2008

Nathan Wilkes' Story

Health Care for All Colorado is incredibly lucky to have Nathan Wilkes on its board. In this video from the California Nurses Association he explains how he became involved in the battle to reform health care.

Think about the fact that the health insurance industry skims off one health care dollar out of three -- and then think about Thomas Wilkes.

How can they sleep at night?

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:
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.

Ezra Klein on insurance reform

Ezra Klein is the best. He's got a couple good posts today, one on the malicious side effects of our perverse health insurance industry, and the other on our cutting off our noses to spite our faces in not giving immigrants health care, which is a disaster for public health.

His post on the insurance market is a link to news that it just became impossible in Washington State for many more people -- including people who've had breast cancer -- to buy insurance on the individual market. Ezra writes,
This is the real problem with reform plans that lack a full coverage component (be it a mandate, voucher systems, automatic enrollment in a national market, or whatever). The issue isn't the folks who will be uninsured, but the damage that does to your ability to reform how insurers work. To create a working market you need to create a fair market. And that means setting up the rules such that neither insurers nor individuals can game the system.
It's probably obvious I think people concerned with single-payer should just go to Ezra's site on a daily basis. He's the best.

Edwards' health plan

Democratic Talk Radio, in publicizing the Daytona Beach paper's endorsement of John Edwards as the Democratic candidate for president, has this synopsis of the Edwards' health plan:
He wants to repeal Bush tax cuts that favor rich Americans and use the money to pay for universal health care. He would require employers to cover their employees or help finance their health insurance.

Additionally, he would lower insurance costs by creating tax credits, expanding Medicaid and coverage for children, reforming insurance laws, and containing health care costs. He would create regional markets to encourage more consumer bargaining power in buying health plans, compel broader choices among insurance plans, and cut costs for businesses offering insurance. Once these are accomplished, Edwards would require all American residents to obtain insurance. It is a bold but realistic reform for this country’s crippled market-based system. [Insurance rates would not be based on current rates because everyone would be included. Coverage would be free or subsidized for those with incomes under $100K. Edwards plan would lead to single payer]
How would it lead to single-payer? The idea is that the Edwards' plan would lead to single-payer because it also calls for a public buy in plan -- so that people like me could buy in to Medicare for All. That's an important element. If it could withstand the corrupting influence of the health insurance industry's lobbyists trying to cripple such a plan it could indeed show that state-guaranteed health care is quality coverage at a bargain -- instead of junk coverage at a premium, as many of us now have.

And thankful for it!

Donna Smith, whose story was told in Sicko, stood at this month's Health Care for All Colorado meeting to say she was uninsured for the first time in her life. Donna is doing great work to better this country, and there's no way she should be left stranded.

What the hell is single-payer?

On Saturday I was cold-calling in person at a conference, approaching people and asking them if they were for single-payer universal health care. It's a bruising thing to do, because you're not insulated from people who are annoyed by your invading their space and people who disagree with your message.

But it's also instructive.

One guy was impatient. "What's single-payer?" he asked. "What is that?"

I began to explain and he cut me off after less than 10 words, saying his life was too short. "You mean socialized medicine," he informed me. "Why don't you just say 'socialized medicine'?"

He went on to say that to him, single-payer is what we already have. He's the single-payer for his health care.

He was so arrogant, dismissive and nasty that I was left reeling -- and wondering what he was doing at a "Faith in Action" conference. I suppose this is why the "heartland" feels the way it does towards academics, because that's all I could imagine that he was. But trying to put it into perspective, his observation was a good one. It's not something that we didn't already know, but it's a confirmation, once again, that the term "single-payer" is a head scratcher.

Guaranteed health care might be better. How would we describe the police or fire departments? Guaranteed police or fire? Universal police protection... with single-payer financing? State police protection? Municipal fire protection? Government-sponsored health insurance?

George Lakoff likes "doctor- and patient-run health care" -- like citizen- and police -run policing?

Or, back full circle, universal health care with single-payer financing?

I'm reminded of the Family Research Council employee who got a month sabbatical to go work for Huckabee. He said that among the things he learned were that the mainstream media were far more fair and balanced than the right-wing media, and that whenever people asked for real information, not just a soundbite, their attention would be gone after 30 seconds. And those were people who wanted to pay attention.

People want things to be easy. We want someone else to have to make the changes, to do things differently, in order to better the system. Mandates are just the ticket for that in many politicians' eyes. Since the majority of Americans do already have Medicare or employer-sponsored insurance, it's a siren call for them to hear that if we just force the uninsured to buy insurance out out-of-control costs will be solved.

They won't be.

Cost-shifting (providers charging insurance companies more to make up from losses elsewhere) is only part of the problem, and only a small percentage of cost-shifting is due to the uninsured. The rest is from Medicare and Medicaid. But even if it were mostly from the uninsured, who really thinks that companies and families would reap the benefits of forcing everyone to buy insurance -- who really thinks the insurance companies would turn around and lower their costs? This is one of the most profitable industries in the world -- has that led them to step back and reconsider their profit margins?

But from what I heard Saturday, a number of people, especially elderly women, are enthusiastic about forcing poor single moms to buy insurance. These seniors were also outraged about their personal out-of-pocket costs.

13 January 2008

Ezra's vision of health care

Ezra Klein spells out his vision of the best health care system possible in this imperfect world:
... a substantially public health care system in which government provides a guarantee of basic services, heavily regulated private insurers fight to compete against the basic plan, and somewhat less regulated private insurers compete with a public insurer to provide supplementary coverage to those who can afford it (those who cannot would be subsidized into the public insurer). ... all this because ... the profit motive is largely pernicious in the delivery of heath care, but nevertheless ... fears ... "no exit," ... it's possible insurers will come up with good ideas that it's worth forcing government to adapt against .... folks should be able to spend as much money on health care as they please -- health care should have a floor, but not a ceiling.

Dems should be for single-payer

At that conference yesterday, I was saddened to hear State Rep. Jim Reisberg (HD 50) talk about how 80 percent of U.S. health care expenditures go to care for chronic diseases, and how almost all chronic disease is caused by lifestyle choices.

It was part of a message of personal responsibility — good enough, but it was also part of a message of blame the victim. Urging personal responsibility should be part of the single-payer message of reform, but it's important to do it in a way that empowers rather than blames.

Rep. Reisberg also defended pharmaceutical profits (in the name of research) and agreed with a woman who talked about the justice involved in making sure that insurance companies can compete across state lines -- emasculating regulations that some states have in place to attempt to rein in insurance company profits and get community ratings.

He's a member of the Health and Human Services Committee. Nicely told me to keep up the good work at the end of the workshop.

On the other hand, Colorado Gov. Bill Ritter gave a good response to my asking if he was for single-payer health insurance. Ritter had talked earlier about the sisters who had educated him, and I reminded him that Michael Moore also had a Catholic education, and that when Moore is attacked about "socialized medicine," his come-back is, "Do you mean 'Christianized' medicine?"

Ritter said that we need to keep educating Coloradans about health care systems, so that reform won't fail.