30 May 2008

Colorado & healthcare reform

Colorado has an unreasonable number of healthcare activists with national prominence.

I'll begin with T.R. Reid, although he's a journalist, not an activist. His Frontline film and upcoming book are and will be important in the debate.

There's Nathan Wilkes, a young father and member of the board of Health Care for All Colorado who speaks nationally on the need for universal, effective, quality healthcare.

There's Donna Smith - who's now in Chicago, but has deep roots in Colorado. She appeared in Michael Moore's Sicko.

David Sirota, the pundit, is here. He's not exclusively about healthcare, but he speaks on the issue, and how it's central to a movement to strengthen the middle class.

Glen Pearson, MD, is former president of Physicians for a National Health Plan.

Rocky White, MD, also on HCAC's board, is running for the State House of Representatives, and is the editor of the reprint of Healthcare Meltdown, a book to read if you're wanting to learn more about the need for healthcare reform.

Elinor Christiansen, MD, was one of the original authors of the first draft of HR676, the single-payer legislation sponsored by Rep. John Conyers (D-MI) and Rep. Dennis Kucinich (D-OH).

In the center there's the 208 Commission, with many of its members being nationally known leaders in healthcare policy, Barb Yondorf in particular, who has co-authored several papers.

On the right, there are Paul Hsieh, MD, and Lin Zinser. The two have an article on "Moral Health Care vs. 'Universal Health Care'" at something called The Objective Standard.

There are a number of single-payer advocates who ignore stuff like this on the grounds that it's mean-spirited. Other activists love to get exercised over this kind of argument, ignoring the fact that most Americans see Zinser and Hsieh's position for what it is - not only mean-spirited but also extremist.

I guess I think it's good to understand where people are coming from, even if you know beforehand that you won't agree. To be a Social Darwinist and still feel good about yourself must require an extreme ability to think in the abstract. For instance, Z&h's first step in fixing what they now acknowledge to be an American healthcare crisis is to repeal EMTALA, the law that requires hospitals to treat people who show up injured or sick at their doors. They'd also eliminate Medicare, Medicaid, and all insurance regulations.

About EMTALA - While the need for the EMTALA law is new, brought about by the distortions of profit in what used to be religious institutions' mission of caring, the underlying value is centuries old - at least as old as Christianity and Judaism.

Z&H give a history of our current crisis, beginning with how Blue Cross/Blue Shield became non-profits, and thereby began to compete with other insurance companies on what Z&H consider an unfair playing field. They believe it became even more distorted after the WWII wage freezes took place, with their concurrent tax breaks for employers offering health insurance.

Z&H compare health insurance to homeowners' insurance, arguing that if homeowners' insurance covered lawn work, painting and remodeling, our homeowners' insurance rates would skyrocket. Especially if the government forced homeowners' insurance to cover poor homeowners...

The problem with that analogy is that homeownership is completely optional - as is, to a lesser extent, upkeep. Health isn't optional. A good portion of what happens to our health isn't choice-driven either. No one chooses their father's stroke proclivity, their mother's and sisters' breast cancer. No one chooses to grow up down river from a chemical plant, or for their mother's crappy prenatal care.

Z&H see Medicare as worse than charity, worse because, they write, people don't realize it's charity. We fools think we've been paying for it via our own taxes.

I'll stop. It's tedious reading someone else's rebuttals to something, and more instructive to do it yourself. The Libertarian notion is that if the healthcare market were simply freed from government meddling it would thrive. It's not a bad intellectual exercise to actually think through what the evidence is against that being true. May even come in handy one day - especially here in Colorado.

Even some of the up-and-coming Colorado politicians are taking notice.

It's too bad the newspapers are out of the loop. Katy Human at the Denver Post does a good job of covering health issues and stories, but the opinion pages have pretty much taken a pass. It would be a public service if they did a better job of covering the issue - with an emphasis on single-payer and modified single-payer, since it is the funding mechanism by which the rest of the world keeps their costs down and provides universal coverage - despite Z&H's ongoing success in ignoring that.

Consumer Reports becomes activist!

There's a great new website and initiative up from, of all organizations, Consumer Reports. It shouldn't really be a surprise - they did some great work earlier this year on the failure of the American health insurance industry.

The Cover America Tour begins with a bus with speakers that's traveling around to bring focus on this issue. Shades of Healthcare Now! That's exactly what Donna and Larry Smith did last autumn.

They're not single-payer, but it looks to me like most of their information points in that direction. Take a look at their media page - one of the choices there is a piece on "Six Prescriptions for Change," which reports the results of a survey of what Americans want (on a page titled: "Health-care security: Losing confidence in the health-care system." Their findings:
  • Coverage for all uninsured children.
  • Protection against financial ruin due to a major illness or accident.
  • The ability to obtain coverage regardless of a pre-existing condition.
  • Coverage that continues even when people are laid off, changing jobs, or starting their own business.
  • Premiums, deductibles, and out-of- pocket expenses that are affordable relative to family income.
  • The ability of people to keep their current health insurance if they choose.
It's too bad that folks don't get it - that last item effectively trumps all that came before.

Cost doesn't equal quality

The renowned education author Jonathan Kozol tells a story about money and education.

The inner boroughs of New York City spent $8,000 or so per student (more now). The outer boroughs about $12,000. The really tony enclaves spent $24,000 per student. At Andover, where Bush went to school, it's $40,000.

When Kozol's conservative friends told him that the answer to our education crisis wasn't to simply throw money at the problem, he liked to reply, "Why not? It works for your kids..."

(I think we can all imagine where Bush might be today - also a federal facility - if he'd gone to an underfunded school in New Orleans or D.C.)

The impact of cost on health care outcomes is different. The rigorous Dartmouth Atlas of Health Care has shown that spending doesn't necessarily correlate with outcome. Now a survey of Medicare beneficiaries released this week in JAMA "suggests that more regional spending on medical care does not improve patients' perception of the medical care they receive..."
The researchers found that per capita expenditures were highly related to receiving more medical care, such as average number of ambulatory visits to physicians in the past year and more cardiac tests (respondents reporting receiving tests in past year, 40.1 percent [lowest average expenditures quintile] to 63.5 percent [highest average expenditures quintile]). However, 7 of the 10 measures of perceived quality, including perceived unmet needs for tests and treatment (respondents reporting unmet needs, 3.9 percent to 5.0 percent) and spending enough time with physicians (respondents reporting adequate time, 88.7 percent to 87.0 percent), were unrelated to expenditures, while the overall rating of perceived quality of care was higher in the lower-expenditure areas (respondents reporting overall care rating of 9 or 10, 63.3 percent to 55.4 percent).

29 May 2008

Coincidence? I think not...

There's an unintentionally funny post at a blog I stumbled over this a.m. regarding Scott McClellan's new book, What Happened. The guy saw a correlation between Bush's falling approval ratings and Scott McClellan's competence as a press secretary. (As if the Bush administration would put an incompetent in a position of importance because of cronyism....) "Even Tony Snow couldn’t reverse the trend," this person wrote.

Somehow I think White House won't go with that. Looks like they've settled on disgruntled former employee sells out for book advance - same as McClellan himself used on Richard Clarke.

A bit of basic logic at Wikpedia gives some other examples of "Correlation does not imply causation":

The more firemen fighting a fire, the more damage there is going to be.
Therefore firemen cause damage.

With a decrease in the number of pirates we have seen an increase in global warming over the same time period.
Therefore, global warming is caused by a lack of pirates.

Since the 1950s, both the atmospheric CO2 level and crime levels have increased sharply.
Hence, atmospheric CO2 causes crime.

26 May 2008

Put a Doctor in the House!

Rocky White, M.D., has a website up regarding his run for Colorado House District 62. Rocky's website looks great - single-payer-financed healthcare is front and center. He writes:
I believe in a single risk pool for everyone in Colorado so that everyone shares in the expense of our health care system according to their ability to pay. I believe that every resident should have equal access to a defined benefits package that ensures a minimum standard of health and welfare for all. I believe that everyone should have a certain degree of personal responsibility for their own health care and that the burden of health care financing should not rest exclusively on the back of business.
The transcript from Amy Goodman's show with Rocky is at Alternet, titled, "Evangelical Doctor Touts Better Health Care Plan Than Clinton, Obama."

Rocky got a brief mention in the Denver Post article on the Democratic State Convention:
One of the few surprises of the weekend was the upset of Rep. Rafael Gallegos, D-Antonito, who was seeking a third term in the House.

Gallegos' own District 62 assembly swept him out, picking Rocky White, a doctor from Alamosa, to be on the ballot. The district covers eight counties in south-central Colorado in an area that includes the San Luis Valley.

White attributed his victory to being well-known in the valley and "just campaigning like crazy."

Gallegos, who received 14 votes, and Ed Vigil, another candidate seeking the seat who received 12 votes, can still petition to get on the ballot.

What ever happened to states' rights?

The Republicans have been so amazingly nimble politically from - what would you say? - 1995 to 2005? - that books will be written a hundred years from now on what they wrought during this crucial time. If, of course, their anti-family-planning, anti-environmental, pro-sprawl, pro-greed, you're-on-your-own polarizing policies haven't precluded publishing.

A NYT opinion piece on states rights offers a chapter of examples on how the right wing, that mighty protector of states rights, has been studiously and quietly stripping the states of their right to protect their citizens.
In February, the day after his infamous encounter at Washington’s Mayflower Hotel, Eliot Spitzer, then the governor of New York, published a remarkable opinion piece in The Washington Post.

He wrote that several years earlier, state attorneys general noticed a spike in predatory lending that the federal government was doing nothing about. When the states tried to rein in abusive mortgage lenders, the Bush administration finally did something. The Office of the Comptroller of the Currency issued rules nullifying state predatory lending laws over the objection of all 50 state banking superintendents.

The clampdown, which paved the way for the subprime mortgage crisis, was done by “pre-emption,” a little-understood doctrine that allows the federal government to wipe away state laws. The Constitution’s supremacy clause says federal law can trump state law. But the federal rule should be a floor, not a ceiling. It should set a minimum level of rights, not stop states from doing more to protect their citizens.
That's just one of 50 examples in an Associated Press report that also includes safety rules for chemical plants, head restraints in autos, abusive Medicare marketing, and curbing greenhouse gases.

One would assume the current makeup of the Supreme Court backs these new rules. That's a Supreme Court John McCain has said he'd strengthen.

22 May 2008

Time predicts healthcare reform

Last week's Time Magazine's cover story was on the economic mess that the next president will need to clean up. The piece ends with a couple paragraphs on healthcare:
Then there's health care, which has become perhaps the biggest source of financial worry and occasional disaster among middle-class Americans. A 2005 study found that half of all personal bankruptcies in the U.S. were attributable at least in part to medical costs.

But there's real hope on this front. It is possible to conceive of a system that brings the 47 million uninsured into the fold, improves medical outcomes and costs less than what we've got now. It's possible to conceive of because many other wealthy countries already have such systems. Figuring out exactly how to make universal health care work in the U.S. is a matter better left to its own lengthy magazine article. But if you're looking for big economic change from the next Administration, this is the form it's most likely to take.
I find that comforting. It means that mainstream journalists, who aren't likely to be single-payer advocates but who are likely to be better read than the average American (not all, but it is part of the job) now get it. This writer, in any case, knows that the data is there. Other countries have shown that healthcare investment can be managed far better than we've accomplished.

There is a real chance that we'll see change in the next five years - perhaps not true universal healthcare via single-payer, but surely steps in that direction.

McCain's startling proposal

Some overworked and underpaid editor at something called "Newsoxy.com" managed to get nearly everything wrong in providing a synopsis of a well-written piece there. He or she wrote:
John McCain wants to bring healthcare costs under control by actively allowing companies to compete around the world.
While I wouldn't put it past McCain to suggest that U.S. companies be "actively allowed" to compete around the world (huh?), a read of the story reveals that this poor editor garbled the last paragraph here:
Other rich similar industrial nations that offer universal care spend only 11 to 12 percent of their gross domestic product on healthcare. Canada spends even less, a bit more than 9 percent of GDP, on a single-payer government insurance system for all its people.

Healthcare advocates say an ambitious change in the United States healthcare system has become an economic necessity, not just a social desire to offer the service to all Americans.

Regina Herzlinger, an expert at the Harvard Business School in Cambridge, Mass. says that the business community bears for 55 percent of the nation's total health costs, the government just 45 percent. Moreover, many businesses eventually want to get rid of their health costs altogether.

"Bringing costs under control is the only way," Sen. John Mccain said on his website, "allow our companies to effectively compete around the world."
Unfortunately, McCain thinks the way to get costs under control is via insurance companies competing with less regulation and more tax breaks. That's worked so well already, after all.

State-Based Health Care Reform Act

Talk about a buried lede. Or the mainstream media not paying attention to an important story. The Milwaukee Small Business Times reports that a bipartisan proposal would let states reform health care - "States could use single-payer systems, expansion of current programs, market-based reforms or adopt completely new ideas in their efforts to cover the uninsured."

U.S. Sen. Russ Feingold (D-Wis.) and Sen. Lindsey Graham (R-S.C.) are authors of the State-Based Health Care Reform Act. Sen. Susan Collins (R-Maine) signed on today.

You can read the bill at the Library of Congress's Thomas.

There's a longer article on the bill at Psychiatry Online from October 2007.
S 1169... would establish the Health Care Coverage Task Force to approve grants to states whose proposals mandate minimum requirements in coverage and quality measures and meet cost guidelines. The bill would provide about $40 billion for state matching grants to expand health care coverage, while mandating certain "cost-sharing" limits to keep the coverage affordable for beneficiaries...

Another state-based approach would authorize grants for states to create universal health care pilot programs that could become models for other states and the country. The legislation, sponsored by Sen. Bernie Sanders (I-Vt.) and known as the States' Right to Innovate in Health Care Act of 2007 (S 2031), would authorize five, five-year grants to states committed to developing plans for universal, comprehensive, cost-effective health care. The states would have to provide comprehensive benefits, including coverage for long-term care, diagnostic services, preventive care, prescription drugs, dental and vision services, and mental health treatment including that for substance abuse.
What's PNHP's position on these bills?

Howard Dean on single-payer

Time Magazine offers up 10 Questions for Howard Dean, DNC chair:
As a former physician, what are your thoughts on the Democratic candidates' health-care plans vs. a single-payer system? Megan Prouty CARROLLTON, TEXAS

I think while someday we may end up with a single-payer system, it's clear that we're not going to do it all at once, so I think both candidates' health-care plans are a big step forward. Certainly compared to Senator [John] McCain, who represents a big step backward.

Unions & Kay Tillow

Kay Tillow keeps plugging away - I get an email from her a couple times a week saying that this or that union has joined the movement and endorsed HR 676, Rep. John Conyers' bill that would create an American single-payer healthcare system by expanding an improved Medicare system.

Four hundred and twenty union organizations in 48 states have endorsed it, including 107 Central Labor Councils and Area Labor Federations and 33 state AFL-CIOs (in the order in which they endorsed: KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA & AK).

Today Kay's email reads:

IBT, APWU Locals and Building Trades Council Endorse HR 676

Teamster and Postal worker local unions and another building trades council have all endorsed HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI).

In New York City, Teamster Local 805 (IBT) has endorsed HR 676, reports Local President Sandy Pope.

In Medford, Oregon, the Southern Oregon Area Local of the American Postal Workers Union (APWU) has also endorsed the Conyers legislation.

In San Diego, California, the San Diego Building and Construction Trades Council unanimously endorsed HR 676, reports Council President Tom Lemmon.


So how improved would this "improved" Medicare be? Sounds pretty good. As Kay puts it, HR 676 would cover every person in the U. S. for 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. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs. The resolution currently has 90 co-sponsors in addition to Conyers. Co-sponsors and bill text are at the Library of Congress's "Thomas."

21 May 2008

The Kennedys and faith

The world at our fingertips can be too much when added to each day's demands. Then comes a reminder of what is actually important. Ezra Klein posted this yesterday. I post it here - selfishly, in hopes that I'll remember to return to it when I'm in the midst of giving up. It's Ted Kennedy's eulogy for his brother Robert F. Kennedy, 8 June 1968 at St. Patrick Cathedral. An excerpt:

"Our future may lie beyond our vision, but it is not completely beyond our control. It is the shaping impulse of America that neither fate nor nature nor the irresistible tides of history, but the work of our own hands, matched to reason and principle, that will determine our destiny. There is pride in that, even arrogance, but there is also experience and truth. In any event, it is the only way we can live."

This is the way he lived. My brother need not be idealized, or enlarged in death beyond what he was in life, to be remembered simply as a good and decent man, who saw wrong and tried to right it, saw suffering and tried to heal it, saw war and tried to stop it.

Those of us who loved him and who take him to his rest today, pray that what he was to us and what he wished for others will some day come to pass for all the world."

The pope chooses saints depending on what he believes are life stories he'd like his flock to emulate. Saints aren't perfect, nor do they necessarily perform miracles in their own lifetimes. Their purpose is inspiration.

For myself and so many others, the Kennedys embody the nobility of spirit and purpose that inspires hope for tomorrow - and thus encourages action, faith and good will today - and forgiveness for yesterday. Judging by the world's response to the news of Ted Kennedy's tumor, most of us have paused during the past day to give thanks for the gift of public service and centered purpose that Ted Kennedy has given. He is truly a lion of a man, a patriarch in the very best sense of the word. He is a father of fathers, to his brothers' children, and a father figure to countless more.

May his remaining years be blessed.

16 May 2008

Surfing dolphins

Reform: it's about economics

After a panel discussion on healthcare, a Denver business leader told me that his group, which pushes subsidization of healthcare and private insurance expansion, cares more about the economics, whereas single-payer supporters are so about expanding access.

I thought about what I had said, and reassessed my talking points. Most of them were about the economics. He didn't hear that, though. For many mainstream business people, universal healthcare is about access -- like Food Stamps are about access to food. Very nice, of course you don't want people starving in the streets of Cleveland or dying outside hospitals in Muskogee, but he's hearing bleeding heart do-gooder while I'm talking economics.

In the same vein, Ezra Klein writes that he doesn't make that point often enough: "Health reform, which is what we mainly talk about, is about economic security more than it's about health improvement. It's about ensuring people don't go bankrupt when they need care, and ensuring the country doesn't go bankrupt in 30 years beneath the burden of health costs."

Klein goes on to write that the real gains we'll make in health improvement will be due to public health gains. I'd add that a lot of our losses in recent decades have been because of a lack of investment in public health and a willful refusal to acknowledge the damages we've done to our environment through industrialization.

Low U.S. medical literacy

It's definitely not Lake Wobegon, "where all the children are above average."

In fact, by definition, half the population is below average -- in anything. Which just goes to show how ridiculously complicated and user-deadly the U.S. healthcare market is. Only about one in ten of us has the skills necessary to successfully negotiate the system and get appropriate care. The only reason we don't know it is because, for the most part, most of us are healthy.

A Medical News Today article cites a study that indicates that just 12 percent of 228 million adult Americans have those skills. The assessment is from the Agency for Healthcare Research and Quality. These skills include weighing the risks and benefits of treatments, being able to calculate health insurance costs, and understanding how to deal with complicated medical forms.

15 May 2008

Commonwealth's proposal

Commonwealth Fund's principal researchers and president have authored an article for Health Affairs with Lewin Group modeling that shows a path to dramatically improving U.S. healthcare. It seems far superior to the flawed Wyden plan.

Health Affairs has a firewall, but you can see a synopsis of the plan at Commonwealth Fund or at Medical News Today.

Here are the basics, from Medical News:
  • A national entity known as a "connector" that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan.
  • Requiring that all applicants be given health insurance at standardized rates regardless of their health status.
  • Tax credits to make sure premiums are affordable. Premium assistance would be available to all to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers.
  • Expanding Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums.
  • Requiring that everyone enroll in a health insurance plan-uninsured individuals who file taxes would be automatically enrolled.
  • Requiring employers to either provide health insurance or pay 7 percent of payroll up to $1.25 an hour into a pool to help to finance coverage.
  • Medicare reforms that would extend Medicare Extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled, and allow adults age 60 or older to buy in to Medicare.

Cammie visits Denver

We went to the Denver Botanical Gardens on Mothers Day - also my mom's birthday this year - and Denver Post photographer Helen Richardson immediately saw how darn cute Cammie is. She took some photos and the reporter, Jessica Fender, began talking with Sarah and Curtis.

Cammie and me? We had nothin' to say. We was busy dancin'.

The story's here.

14 May 2008

The Republican corporate prescription

All is revealed with the GOP's new slogan: "The change you deserve," borrowed, we now know, from the antidepressant drug Effexor.

The difference, of course, is that the Republicans don't have to reveal side effects to potential consumers.
"Are depression symptoms keeping you from where you want to be?" Effexor's maker, Wyeth Pharmaceuticals, asks in its promotions. "Not feeling as good as you used to?"
House Majority Leader Steny Hoyer (D-Md.) told reporters today that a safer remedy would "Democrats, not drugs, is what the American people need," he said. He flashed the Effexor side effects on a large flat-screen television. "Nausea, up to 58 percent," Hoyer said. "Actually it's higher than that for Republicans."
Hoyer didn't even mention the warning label, which states that patients should be watched to see if they are "becoming agitated, irritable, hostile, aggressive, impulsive, or restless."
All so true.

Also in the news today was the sad fact that relentless for-profit marketing has turned Americans into a bunch of pill-poppers. More than half of all insured Americans are taking prescription medicines regularly for chronic health problems. The causes are worse public health, better meds, and advertising. The biggest jump in use of chronic medications was in the 20- to 44-year-old age group where it was up 20 percent over six years. The chronic conditions served are mainly depression, diabetes, asthma, attention-deficit disorder and seizures.

There are some good books out on the pharmaceutical industry's success in the United States. Here are four, with their descriptions from Amazon:

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, by Shannon Brownlee
Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is.

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, by Melody Petersen
Much of what [former New York Times reporter Petersen] recounts — such as the glut of copycat drugs like antacids, and marketers' lavish wining and dining of doctors—has been covered in books by others, like Marcia Angell. But Petersen fleshes out these issues and names prominent doctors who, she says, are on the take. She is particularly strong on the ghostwriting of medical journal articles by advertising agencies. She also covers less familiar matters, like the environmental impact of drug residues in water.

Before You Take that Pill: Why the Drug Industry May Be Bad for Your Health," by J. Douglas Bremner
Recent scandals involving diabetes drugs, Vioxx, and many other medications reveal the serious and undisclosed risks of some of the most commonly used prescription drugs in this country. Dr. Bremner, a researcher and clinician at Emory University whose study on Accutane and depression made headlines, offers an inside look at the pharmaceutical industry, as well as a scientifically backed assessment of the risks of more than three hundred prescribed medications, vitamins, and supplements.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It, by Marcia Angell
The pharmaceutical industry, according to former New England Journal of Medicine editor Angell, is fraught with corruption and doing a disservice to customers, the federal government, and to the medical establishment itself. She explains how a huge portion of the revenue generated by "Big Pharma" goes not into research and development but into aggressive marketing campaigns to sell their product. She describes how, even though the drug companies claim that it costs them an average of $802 million per drug to develop new medicines, that figure is obscenely inflated since it factors in marketing as well as expected interest the company would have received had they invested the money in the open market. Meanwhile, most of the R & D work is done by colleges and universities funded by the government. There are also problems with the drugs themselves, since a majority are "me-too drugs", slightly modified versions of existing products which meant to address concerns of consumers most likely to spend money on pharmaceuticals. Thus, the market is filled with remarkably similar drugs to treat depression and high cholesterol while potentially life-saving medicines for diseases afflicting third-world countries are discontinued because they aren't profitable.

Colleges not covering students

One of the givens for college used to be health coverage. No more. Business Week has an article on health care falling apart for college kids as well -- probably the healthiest demographic there is. "Is your kid covered?" notes that insurance companies make big profits here, but leave some families with big bills. Those would be the families whose kids get sick.

If for-profit insurance can't even cover college kids it's worse than worthless.
More than half of the insurance plans recommended by colleges offer benefits of $30,000 or less, according to a survey published in March by the General Accounting Office, an arm of Congress. Many plans have further limits that prevent payout of even modest maximums...

The vigorous health of most college students helps make insuring them a lucrative niche, according to industry consultants. Most insurance companies, even if publicly traded, don't break out separate financial results for their student-oriented policies. But some schools disclose an indication of the profitability of policies sold to their students: the so-called benefits ratio. This shows the percentage of premiums returned to customers in the form of benefit payouts. Large health insurers typically have overall ratios of about 80%, meaning 20% of premiums goes to profits and administrative costs.

In several cases where BusinessWeek (MHP) was able to obtain benefits ratios from colleges or universities, the percentage was well below 70%. Anything below 75% ought to be grounds to negotiate a better deal, according to Eric Engstrom, president of Keeling & Associates, a consulting firm in New York.

At Palm Beach Community College, the benefits ratio for the spring semester of 2008 was 42.6%, according to reports provided to the school by UnitedHealthcare.

In previous semesters the benefits ratios dipped as low as 10.2% and 13.8%. This means the college's plan has been a veritable gold mine for UnitedHealthcare. At the University of South Florida in Tampa, which offers a plan from American Fidelity Assurance, the ratio this academic year is 35%, down from 71% and 61% the previous two years, respectively.
Did you get that? UnitedHealthcare paid out as low as 10.2% in benefits some semesters. Compare that to 97% for Medicare or Canada's universal health care plan (also called Medicare).

Now here's the key to change. Upon finishing that article in Business Week, do most readers:

a) Look into healthcare to find out for themselves what's wrong with our so-called system,

b) Protect their own kids by ensuring that Max and Jessica are still fully covered under dad's plan, or

c) Call their broker and invest in UnitedHealthcare.

13 May 2008

Moyers covers the Cal Nurses

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.

09 May 2008

Private insurance hurts U.S. businesses

Len Nichols and the New America Foundation have released a great paper, well sourced and with great charts and tables, showing the private health insurance's effect on global competitiveness.

Here's one of the charts:

Download the pdf for Employer Health Costs In a Global Economy at the New America Foundation website.

Reality trips up D.C. mandates

The Washington Post reports that D.C. Council member David A. Catania (I-At Large) has reconfigured his plan to get universal health care to all D.C. residents. This is good. Catania's plan was a mandate, with a $250 fine for anyone who didn't buy health insurance, with subsidies only up to 200% of the federal poverty level - about $21,000.

George Jones, executive director of Bread for the City, shares his hopes and concerns in this May 4 article, with the piece on Blue Cross/Blue Shield's less-than-straightforward negotiations over the plan here. Jones cites Massachusetts as exhibit #1 as to whether fines work to force people to sign on for overpriced, largely worthless insurance.

Walter Smith, executive director of the public advocacy group D.C. Appleseed Center for Law and Justice, notes that Blue Cross/Blue Shield, as a federally chartered nonprofit, is legally bound to contribute to the community.