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.

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.

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.

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.

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.