Ave Cassandra

Why "consumers" can't drive down health care costs

2011-07-12T08:56:00.000-07:00

Bloomberg has a great article up about how impossible it is to find out how much medical procedures cost. Mimi Ferraro spent hours trying to find the least-cost provider for an injection of cancer medication she needed. She made her decision based on information that came after numerous calls - to the insurance company, which told her it couldn't give an estimate on the cost until after she'd had the procedure (!) and then a week of waiting on the answer from her oncologist's office. It was wildly inaccurate. She paid $4,099.51 for a shot she was told would be about half that much. She could have gotten it for half that much at a local pharmacy - but it wouldn't have counted toward her deductible. Her high deductible, that is.

This kind of [high deductible] insurance is expected to help reduce health costs. Given a need to make higher upfront payments, patients may be more selective about the services they buy and keep spending low. But there is a significant flaw in this reasoning: Patients aren’t the ones who make the decisions about which tests and procedures to purchase. Doctors are. And doctors, along with hospitals and insurance companies, don’t let on how much the services cost.

Another significant flaw is that a plethora of studies have shown that people do not make good decisions about health care spending. They balk at spending for preventative measures and, when panicked, will spend far too much when it's too late. Not that they know how much they're spending.

Ferraro pulled together some studies that show no one knows what procedures will cost. She thinks that if every patient demands the cost information that she was asking for, costs will actually become transparent. I absolutely disagree. It's not in anyone but the patient's interest to make that transparent, and our for-profit system isn't set up to benefit the patient. Excuse me. I meant the consumer. I would also point out that not only are U.S. health care consumers blindfolded, this kind of treatment is emotional torture and very bad for your health.

But most Americans can tut-tut. It happens to someone else. We look for what they did wrong - like get sick, for instance - and feel reassured that it won't happen to us.

Who needs foreign-born terrorists to wreck our communities when we've got insurance companies!

Think again if you think being insured = security

2011-07-06T07:48:00.000-07:00

Americans love to believe things that are demonstrably untrue - tax cuts equaling increased government revenue and a stronger economy, for starters. Oh, and the whole idea of for-profit insurance companies being an efficient way to finance our health care being another.

So I'm just passing this along - it's not going to make a whit of difference in the debate. The University of Arizona has found that being insured doesn't affect whether you have medical debt.

According to a study published online June 16 by the American Journal of Public Health, after taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications....

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt. From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

That's according to University of Arizona College of Pharmacy research scientist Patricia M. Herman.

But don't expect the Americans who are swayed by the big-business money that preaches anti-government ideology to take note. (Hell, the mainstream media didn't even take note.)

They're busy admiring Michele Bachmann's poll numbers in Florida, leaving the fact that she's a delusional liar to, at best, the papers' online blogs, to be read by the choir.

Social darwinist Bachmann is quite concerned about a mythical $105 billion "hidden" mandatory spending in the health care reform bill passed last year. That would be the most-debated bill ever passed. Right, Michele.

And the shot heard round the world was fired in New Hampshire. Uh huh. Obviously memory fails us all now and then. But when a third or so of Americans begin to channel the single-minded Walter Sobchak (You're goddamn right I'm living in the fucking past!") from The Big Lebowski, it's hard to know where to begin. As The Dude says, "Walter, I love you, but sooner or later, you're going to have to face the fact you're a goddamn moron."

The scary thing is that these folks aren't just channeling film rage, they and their leaders are unwittingly channeling mass murderers. Bachmann again: “But what I want them to know is just like John Wayne, who is from Waterloo, Iowa – that’s the kind of spirit that I have too.”

As one L.A. Times commenter wrote, "I don't think she was mistaken, she was just speaking in secret code to her minions. She well intends to rape the nation like [John Wayne] Gacy [who was from Waterloo] did to his victims..."

Another commenter offered a SOP right-wing solution: "Let's go to John Wayne's Wikipedia page and change it so that she is right."

More Docs Reject Privately Insured Patients!

2011-06-29T07:17:00.000-07:00

A study expecting to find even fewer doctors willing to accept new Medicare patients found, sure enough, a modest drop in that percentage. But the shocker was a far steeper decline for doctors willing to accept privately insured patients.
The study shows 93.3 percent of doctors accepting insurance for payment in 2005, and 87.8 accepting insurance in 2008.

The drop for those accepting Medicare coverage during the same time was 95.5 percent down to 92.9 percent. Not the huge difference the right-wing media has been harping about - and they seem to have missed completely the fact that some doctors turn away patients wanting to pay with private insurance.

I first heard of this a few years ago with a doctor in Fort Collins, Colo., who wouldn't accept private insurance. He said he did so so he could practice medicine instead of argue with bureaucrats whose primary concern was profit, not patients. The insurance companies also didn't pay him enough - and he's a family doctor, not a country-club suburban specialist.

Dr. Tara Bishop's study was in the 27 June 2011 Archives of Internal Medicine. She's assistant professor of public health at Weill Cornell Medical College and practices at New York-Presbyterian Hospital/Weill Cornell Medical Center. Dr. Bishop is concerned that the growing numbers of physicians saying no thanks to insurance companies could bollocks up President Obama's reform - which depends on everyone buying private health insurance from this deadly industry.

It's one more reason to simply expand Medicare to cover everyone.

There are economic sectors where the free market delivers most effectively, no doubt. Manufacturing computers and running casinos come to mind. Other tasks - like covering the cost of health care, fighting fires, policing our communities, educating all the children - societies that tax themselves to provide those services for all come out ahead.

Pretty simple. You want the Pakistan model or Paris?

Ave Cassandra Is Back

2011-06-21T08:55:00.000-07:00

Back in 2007 or 2008, a marvelous guy running for state representative here in Colorado sat down and talked with me about universal health care. Joe Miklosi is a smart progressive who already knew that the U.S. system is fatally dysfunctional. So I was preaching to the choir.

But at the end of our talk, he did something no one else had. He gently touched my arm and asked me if I was taking care of myself - or if I was reopening a wound every time I shared my brother's story. Hmm. I assured him that working for health care reform was my way of working through my grief - so that no one else would have to lose someone the way we had, etc.

Hmm. In fact, I was pouring salt in the wound on a daily basis. As it turns out, I'm also very bad at organizing and activism. You have to be well organized and optimistic to be good at activism!

So I quit. And now I'm back, but just at Ave Cassandra, not at Health Care for All Colorado, a great group of activists but not for me. I'm not going to post every day, and no more salt, no more activism. I'm just going to pay a bit of attention again. And share the good stuff. And continue to urge my adult children to emigrate to a country with social policies that demonstrate concern for community, including people who are sick. WWJD and all that.

Second Amendment Health Care

2011-06-21T08:14:00.000-07:00

Richard Verone had a growth in his chest, ruptured disks, and no health care. Typical 59-year-old American. Not the majority, but typical. He figured his care might take three years. So he robbed a bank.

Not so that he could get the cash to go to India for care, or to buy into the expensive insurance for folks with pre-existing conditions. Both of those options might cost more than the bank even had on hand, and besides, someone might get hurt. Think it through: all kinds of things could go wrong. Just the time in jail would do it, he figured. So he handed a note to the teller that demanded $1. The note said he was armed. Then he sat down and waited for the police.

The fly in the ointment is that, according to news reports, he's very likely to get just 12 months, not three years. He wasn't carrying a gun, so it's a lesser charge. Kind of unAmerican of him, now that I think about it. What - he's not in favor of the Second Amendment?

First They Came for the Uninsured

2009-07-22T18:52:00.000-07:00

When the Nazis came for the communists,
I remained silent;
I was not a communist.

Then they locked up the social democrats,
I remained silent;
I was not a social democrat.

Then they came for the trade unionists,
I did not protest;
I was not a trade unionist.

Then they came for the Jews,
I did not speak out;
I was not a Jew.

When they came for me,
there was no one left to speak out for me.

- Pastor Martin Niemöller

Overwrought to compare that to the U.S. healthcare crisis? Perhaps. It probably feels different if you haven't lost a loved one because of it.

Pastor Niemöller's point is that if a society doesn't value solidarity - even solidarity to protect those in disagreement with one another - then we allow predators to pick us off.

Solidarity is a value often mentioned in other industrialized nations. Not at all in the U.S., where it sounds subversive - doesn't it?

Death as a Rorschach Test

2009-07-22T18:35:00.000-07:00

After a post at Slate I realize, once again, that Paul's death is a kind of Rorschach Test.

Usually people who are in favor of healthcare reform get it, immediately - how the U.S. healthcare system failed him in a far bigger way than misdiagnosing his appendicitis.

Physicians almost always get it immediately.

People who are afraid of change, and who don't understand that our health care system is a kind of ever widening net of dysfunction - not so much. For them it's all about misdiagnosis - if they've gotten past the point where it must have been Paul's fault, because the U.S. healthcare system is the best in the world (maybe needs a slight tune-up, but nothing major) - that being the case because we're the best.

And once a group starts thinking it's the best despite all evidence to the contrary, that's the beginning of the end, whether it's a sports team, an automaker, an army or an entire nation.

The United States does a lousy job of protecting what it claims is its most precious asset - its people.

Soft Support for Reform

2009-07-22T12:40:00.000-07:00

Back when politicians thought all healthcare reform could be was adding a few more kids to the SCHIP program, just like every other single-payer supporter I know I liked to point to polls showing that a majority of Americans knew we needed to overhaul our system, that government needed to guarantee healthcare, that it was the dastardly insurance industry's grip on our politicians that was to blame and so on.

All along there were the Celinda Lakes warning that public support for healthcare reform has always been soft, and easily manipulated by fear-based campaigns.

Like this, you think?

RX FOR DISASTER
83 MILLION OF US WON'T KEEP OUR INSURANCE

And for those who do manage to keep their current insurance -- well, it won't cost $2,500 less, as Obama promised. Lewin estimates it will cost $460 a year more because of new cost-shifting from the government-run plan to private health plans.

That's right. The $1.3 trillion House health-care bill would cause millions of Americans to lose the insurance they have now -- while the rest of us would pay even more than we do now.

It's times like this when you truly appreciate the smart analysts out there, like Paul Krugman and Ezra Klein - who quoted Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

They say that people deserve the governments they endure - a pretty hardhearted assessment of, say the Cambodians under Pol Pot. But when it's a democracy, and when there's every opportunity to become educated, wouldn't it be true to say that a people deserves the health care system they're too afraid to change?

I'm feeling like picking fights about this - pretty unproductive I admit.

Flurry of Pundits on Healthcare Reform

2009-07-21T14:39:00.000-07:00

Health Reform Can Pay for Itself, by Timothy Noah at Slate

Why Health Care Reform Will Pass, by Jonathan Chait, The New Republic

More Disapprove than Approve of Obama on Healthcare, Gallup Poll

Real Consequences of Inaction, at Healthcare NOW

Will Obama Wipe Out on Healthcare?, by Howard Fineman in Newsweek

Healthcare for Dummies, by Dana Milbank in the Washington Post

Americans: OK with Inequality

2009-07-21T14:30:00.000-07:00

Jacob Weisberg has a nice piece at Slate on the reform package. What really caught my attention, however, was this commenter:

Weisberg writes: "[The British system] doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s..."

The PSA is more likely evidence of what's wrong with the US system, not what's wrong with the British. It has become a standard even though there is little, if any, evidence it saves lives. Yesterday's NY Times ran a story that pointed out, "the federal Centers for Disease Control makes it clear on its Web site: there is no medical proof yet that routine screening for lung, ovarian, prostate and skin cancer reduces deaths from those cancers." But many men will suffer wretched complications from treatments in response to the screening.

But that's my minor quibble with Weisberg. The major one is this: "Morally speaking, Americans are surely more accepting of economic inequality than their European brethren. But the random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the social conscience."

If only it were true that the bad health, disabilities and deaths that result from the lack of access to health care really offended Americans. Sure, there are some who are really outraged, some who are disturbed, and others who just can't be bothered to think about it. But there is also a group (large or not?) who are really satisfied knowing that there are winners and losers in American life and they are only too happy to be on the winning side. If we acted to create a more equitable system, how would they know who the winners and losers are and which side of that line they're on? Knowing that others are suffering, and believing that everyone in life pretty much gets what they deserve to get, they oppose any change that would bring relief to the suffering or make life "fairer."

Those who are passionate about universal care aren't large enough in numbers to bring about a change. Those who aren't passionate are too disturbed at the thought that reform may bring some change to what they already have to support it. And those who are happy with the way things are aren't going to support any change at all. If any reform bill passes it will have to be diluted too much to avoid imposing real change on health care providers or the currently insured. We're going to fall short again.

No doubt we'll fall short for just those reasons, although I sure hope that Obama gets us on track to a solution.

This comment makes me think about hearing some asinine Republican representative on C-Span last night pontificating on how every American has access to health care - it's just that not all of us have health insurance - two very different things, he wisely noted.

Right. Tell it to my brother. Tell it to all the American parents and children who've died because they did not have health insurance - and because they did not have health insurance they did not go to the doctor in time, and because they did not have health insurance the hospital treated them differently than had they been insured.

And I think about some commenter on a radio station saying that he sure did expect to have better health care - far better health care - because he was insured - otherwise what the hell was he paying for?

Full Court Press

2009-07-15T10:20:00.000-07:00

It was all healthcare all the time on talk radio this morning. On the road this morning I heard some conservative literally spit into his microphone over how crazy it was for something that was supposedly free to actually cost a trillion dollars and how there's a long waiting list for programs - just as there would be once it was enacted for people to see their doctors. He also alluded to the idea that you wouldn't be able to get aspirin.

Pretty crazed stuff, but no doubt straight off the Republican talking points. Emphasize waiting, emphasize cost, emphasize a loss of personal control - all of which happen to be false, but still. Great talking points.

On to NPR where some WellPoint exec is claiming that Medicare is less efficient and innovative than private insurance companies.

Really.

On to the librul station where, without a skipped beat, Big Ed was glad that David Axelrod had finally made a shot over the bow to the Republicans that if they weren't willing to go along with the program then healthcare reform didn't need to be bipartisan.

He read this quote: "Ultimately, this is not about a process, it's about results," David Axelrod, Obama's senior political strategist, said during an interview yesterday in his White House office. "If we're going to get this thing done, obviously time is a- wasting." Both Axelrod and White House Chief of Staff Rahm Emanuel said taking a partisan route to enacting major health-care legislation isn't the president's preferred choice. Yet in separate interviews, each man left that option open.

"We'd like to do it with the votes of members of both parties," Axelrod said. "But the worst result would be to not get health-care reform done."

Paying for it will be the taxes on the wealthy - and it is curious how the Republicans can rail against that and at the same time denounce excessive bonuses - like the ones announced today at Goldman Sachs, where the average employee bonus is nearly $900,000 and top execs will see tens of millions.

Come on. You're not in favor of taxing that?

Public not so keen on the Public Option

2009-07-09T11:13:00.000-07:00

People really do have an amazing font of ability when it comes to ignorance.

Once you understand something - like, for instance, that single-payer health care works, or that the U.S. is the only country in the world to allow private industry to act like racketeers in regard to citizens' health - there's often a sense of surprise that other people still don't get it.

Really? You don't get that? That the earth orbits the sun? That the moon orbits the earth? You weren't aware of that?

On the radio this morning comes a segment about Rep. Ed Perlmutter (D-CO), who is educating folks on the public option. (Thanks Ed - you're leading. It's appreciated.)

He invited some 5,000 of his Colorado constituents to chat with him about health care and the public option. He invited people who get his newsletter, presumably slanting Democratic, and then people randomly selected from his district. Questions at the chat included one guy noting that it's just common sense that if you cover everyone it must cost more, so how can single-payer proponents claim otherwise?

A poll on whether people were in favor of the public option found 54 percent against.

Defending the Indefensible

2009-07-07T09:02:00.000-07:00

The case of a rejected potential mate came up in conversation with friends over the weekend. This loser's biggest fault? She was Catholic - which led everyone around the table to enthusiastically agree to hating the Catholic Church.

I was silent though I usually speak up at such moments. It's been infinitely more difficult to defend religion in general since Bush was elected... OK - it was always difficult to defend a group that raised the fetus to the point of idolatry, where abortion - rather than faith or personal sacrifice for justice - became the sine qua non for believers. At my weekend table I had to also wonder if the whole bit weren't some kind of passive-aggressive hostility aimed at me, since everyone there knew I'd worked for the Church for 16 years.

Instead of speaking up I was thinking of the editor at the Catholic Sentinel, my old boss, saying that Catholicism was the last bastion of respectable bigotry. It's no longer acceptable to hate African-Americans, Asians, gays, Islam, Judaism, or paganism, but it's OK to hate the Church.

Now that's a bit over the top, a bit Bill Donohue and Catholic Leagueish - after all, if someone vehemently disagrees with a powerful organization's policies because those policies do quantifiable harm, it's disingenuous to put that criticism down to prejudice. Eric Alterman and other critics of Israel's policy towards the Palestinians are not anti-Semitic. For crying out loud, Alterman is Jewish. As the Israeli state increasingly became identified with its wall and settlements, however, it became harder and harder to criticize those policies without sounding anti-Israel in general. Especially since Israel's defenders themselves evidently defined Israel by those policies. The same is true for Republicans, the anti-government, don't-believe-in-global-warming, Christianism party, and for the Catholic Church, the church of anti-contraception and no-abortions-even-to-save-the-life-of-the-mother faith.

Shouldn't Israel, Republicans, and the Church be more than that? It seems like they should do their part in helping those of us out here who would like to come to their defense in a fair-minded way.

Then there's the related problem of in so doing becoming aligned with frothers who insist that the entire Democratic Party is anti-Catholic. Right. Pelosi, Kennedy, et al.

Someone else over the weekend, in a completely different conversation (this one about the Church coming out strongly in favor of the coup that ousted Honduras's leftist president), said that they really didn't like this current pope's leadership.

Now that's a fair criticism.

Americans support a public option

2009-06-21T14:45:00.000-07:00

A New York Times/CBS News poll shows overwhelming support for a public option - 72 percent of all those polled were in favor, with 20 percent opposed and 7 percent clueless.
Half of Republicans were in favor (39 percent opposed).
87 percent of Dems were in favor! (9 percent opposed).
73 percent of Independents were in favor (22 percent opposed).

And yet Senate Dems are not on board.

What is wrong with this picture?

Contact your senators! Here's an Howard Dean petition - there are others as well.

Public Option Good Politics

2009-06-16T11:22:00.001-07:00

Robert Creamer has an article at Huffington Post on Four Reasons Why Giving Consumers Is Great Politics.http://www.blogger.com/img/blank.gif
He cites the popularity of such a program:

In a poll taken earlier this year by Lake Research, 73% of respondents favored a health plan that gives them the choice between a private plan or a public health insurance plan. Only 15% preferred to have only the choice of a private plan. And the preference for a choice between public and private health insurance plans extends across all demographic and partisan groups, including Democrats (77%), Independents (79%) and Republicans (63%).

According to an NPR report, "Republicans argue that upward of 100 million Americans would opt out of private insurance in favor of a public plan if such a plan were available."

And yet the story is being spun that Congress would never pass such a thing. Haven't we gotten to the point where nearly everyone understands that our healthcare system sucks, that other countries do it better, and that they do it better because there's a government guarantee of healthcare?

Lincoln was for govt-financed health care

2009-06-04T09:09:00.000-07:00

James Nowlan, a Republican at the University of Chicago, has a column in today's Chicago Tribune. It's notable both for what it says and what it doesn't say.

"Abraham Lincoln declared that government should do only that which the people cannot do so well for themselves -- defense, highways, public safety, education. And government has done a good job of fulfilling this compact with the public. In recent decades, we have been adding health care to the compact, in increments: first the elderly with Medicare, then the poor, and more recently, children, both through Medicaid. If you're not in one of these categories, you scramble for health care. Everyone in my rural area hustles to find the shelter of health-care coverage. Farmers' wives take jobs at the school in town -- for health coverage for the family. Whenever a job change is contemplated, the biggest question is: 'Will there be benefits [health coverage]?'"

Nowlan addresses the irreconcilable tension between Americans believing that their taxes are too high and at the same time believing that the government should make sure everyone has health care.

Then, as if he can't quite help himself, he points out that Medicaid and Medicare are the biggest chunk of government expenditures on health care - something that is misleading because it doesn't note the other government expenditures on health care, such as the tax breaks for companies that provide health insurance and the cost of paying for private insurance for all municipal, county, state, and federal workers, including the military.

He notes that the cost of Medicare and Medicaid have gone up 7 percent a year, "far outstripping inflation," without noting that the rate of increase of private insurance puts Medicare and Medicaid increases in the dust.

Even so, the quote from Lincoln was nice. The experience of other industrialized democracies fairly proves that government does a better job of managing health care financing than does the private sector. (If, of course, you factor in health of the population as being at all important. If you're willing to write off a substantial portion of your work force - the Darwinian cost of doing business - then our system clearly is more profitable and therefore better, capitalistically speaking.)

Then again the right has so vilified the competence of the American government that it's possible that people think that whereas the Swedish or German or Taiwanese government can competently manage health care financing, our own government cannot.

The question then becomes "Why does the right wing hate America?"

Baucus says he shouda listened

2009-06-03T16:03:00.000-07:00

Well yeah. Politico reports that "Senate Finance Committee Chairman Max Baucus (D-Mont.) told leading advocates of a government-financed health care system that he made a mistake by not giving their proposals more consideration in the reform debate, according to participants in a meeting Wednesday."

Bernie Sanders (I-VT), a single-payer supporter, arranged the meeting with David Himmelstein, MD, and others.

Those involved in the health care negotiations say single payers have been elevated precisely because Baucus excluded them. Baucus has been able keep almost every interest group involved in the process from speaking out against the ideas under consideration. But because they are not involved, single payers have been one of the only vocal constituencies hammering away at Baucus.

The virtual shut-out has emboldened the movement.

After being left off the invite list for the White House health care forum in March, single payer advocates alerted the media and won a seat at the table. They disrupted each of the Finance Committee’s three roundtables on health care in April and May.

How many are underinsured?

2008-06-13T20:24:00.000-07:00

Commonwealth Fund has just released a stunning report on underinsurance in the United States. "Insured But Poorly Protected: Number Up 60 Percent in 4 Years", finds that, "Rate of Underinsured Triples for Middle and Higher Income Families; Underinsured Go Without Needed Care and Face Medical Debt."

It's great to have these figures - even though they understate the problem. The report found that there are 25.2 million underinsured Americans - "based on their out-of-pocket health care costs relative to their incomes." That leaves a lot of underinsured people uncounted.

Here's the full text of the Health Affairs article, and here's an interview that the report's lead author, Cathy Schoen of the Commonwealth Fund, did with PBS. There's both a video and transcript there - and links to resources like this - U.S. vs. other nations.

Podemos con Obama

2008-06-06T22:18:00.000-07:00

Hike the gas tax

2008-06-06T21:15:00.000-07:00

Wednesday midday I was at National Airport drinking a coffee that tasted like boiled shoe leather at the end of a bar. An outlet lured me there. National strikes me as the worst airport in America for keeping your laptop charged before you get onto the plane and can't recharge. Why so few outlets?

So there I am, answering emails and trying not to listen to the bartender talk up a couple who were slurring a bit before they even sat down. They plowed right into slugging back beers and mixed drinks. The Metro's not so bad, the bartender says to them. That's a recent discovery for her, forced by the fact that she's got an SUV. She's going to buy something smaller when she can afford it. Yep, her customers agree. They may need a few more before flying, but they're no fools. "Those SUVs," the guy says, "we all just bought 'em because they looked so cool."

Charles Krauthammer, one of the Washington Post conservatives, has a great column on how Americans have shot ourselves in the foot - or the bicycle tire, or something - with our refusal to tax gas. He doesn't mention the fact that big business and the Republican Party have engineered that situation by instilling fear and distrust of the very government that we're supposedly so proud of. Democracy or republic or whatever.

We've crippled ourselves regarding healthcare and transportation alike - both of which are essential for a vigorous economy.

If, however, you're wedded to the YoYo ideology - you're on your own - that cowboy mythology of individualism over community, then it's hard to get behind any kind of scheme that would benefit everyone - including future generations. Like, for instance, universal healthcare or a gas tax. That's despite solid data from elsewhere that it strengthens the middle class and makes children's lives better. Not a problem in America, where we're all on the verge of winning the Powerball, and will no longer be part of that middle class anyway. And our kids? YoYo.

Enough ranting. Here's Krauthammer:

Unfortunately, instead of hiking the price ourselves by means of a gasoline tax that could be instantly refunded to the American people in the form of lower payroll taxes, we let the Saudis, Venezuelans, Russians and Iranians do the taxing for us -- and pocket the money that the tax would have recycled back to the American worker...

Want to wean us off oil? Be open and honest. The British are paying $8 a gallon for petrol. Goldman Sachs is predicting we will be paying $6 by next year. Why have the extra $2 (above the current $4) go abroad? Have it go to the U.S. Treasury as a gasoline tax and be recycled back into lower payroll taxes.

Announce a schedule of gas tax hikes of 50 cents every six months for the next two years. And put a tax floor under $4 gasoline, so that as high gas prices transform the U.S. auto fleet, change driving habits and thus hugely reduce U.S. demand -- and bring down world crude oil prices -- the American consumer and the American economy reap all of the benefit.

Medicare Meets Mephistopheles

2008-06-05T20:29:00.000-07:00

That's the title of a 2006 Cato Institute rip on Medicare. Here's the spin, via Amazon: "Let's say you're the devil, and you want to corrupt the American republic. How would you go about it? According to David Hyman, you might create something like Medicare, the federal health care program for the elderly. Hyman submits that Medicare may be the greatest trick the devil ever played. Medicare feeds on the avarice of doctors and other providers, turns seniors into health care gluttons, and makes regions of the United States green with envy over the dollars showered on other regions... With epic political battles over Medicare and the future of limited government looming just over the horizon, Hyman uses satire to cast a critical eye on this mediocre government program."

You can pick upMedicare Meets Mephistopheles, for $1.40 from Amazon or $14.95 from Cato. Your choice as a consumer in a market that actually works - unlike the free-market healthcare biz. The New England Journal of Medicine had a January 2007 review:

Hyman is surely correct that current financial trends in Medicare funding are unsustainable and will eventually erode public support. But in focusing on Medicare's inadequacies and mocking the system as an intergenerational scam (my word, not his), Hyman overlooks the reason why Medicare was enacted in the first place and why it retains considerable public support. At its inception, Medicare addressed the palpable medical needs of the elderly and the failure of the private insurance market to meet those needs. The program reflected a set of values and social commitments that included universalism, government responsibility for social welfare, and public accountability.

More important, Hyman ignores the reality that many of Medicare's flaws are at least rivaled, and perhaps exceeded, in the private sector. It is doubtful that the private sector would match Medicare's considerable strengths in providing access to health care that was unavailable before the program was introduced. Whatever its failures, there is evidence that the program has clearly improved the lives of its intended beneficiaries. As J. Lubitz and colleagues wrote in Health Affairs ("Three Decades of Health Care Use by the Elderly, 1965–1998") in 2001, "Our findings are consistent with the idea that Medicare-funded services have improved the health of the elderly." Is there any legitimate nonideological reason to believe that consumer-driven health care will better serve the elderly than Medicare? I am dubious.

Still, Hyman's bracing critique reflects the fact that neither Medicare's problems nor the ascendancy of market-based approaches to solving them can be ignored any longer. In an era of rampant individualism, the attempt to defend Medicare's collective ethos has the aura of a reactionary battle waged to save an old order in the midst of its last throes. Those who support the social obligations underlying Medicare must demonstrate anew why market-based solutions are unappealing and why governmental investment in health care is morally justified.

Here's hoping that Obama means new hope for social obligations.

Military benefits from desperation

2008-06-05T19:25:00.000-07:00

The Wall Street Journal blog shares a NYT article on how healthcare reform could hurt military recruiting goals. Turns out that when an illegitimate war drags on, when troops are abused, and when people realize that a war is illegitimate and troops are being abused, young people don't sign up to fight.

The NYT piece is accompanied by a chart showing that in the late '80s, 25 percent of young people figured they'd sign up for military service during the next few years. Now only 13 percent think that's a reasonable choice.

Young people signing on to military service evidently say they're partly motivated by medical need for their young families. Tricare for their spouses and children is a trade-off for signing up for Bush's war. "It seems a bit perverse that the incentives for a young person with children to join are greater than the incentives for his childless friend," writes Floyd Norris in the Times. "But that is the way it is. All that could change if the push for some kind of national health insurance program were to be successful."

Donna Smith's new blog

2008-06-03T09:17:00.000-07:00

The indomitable Donna Smith has a new blog at guaranteedhealthcare.org that I'll begin checking regularly. It's got 11 contributors, and so is almost certain to have new news and comments several times a day. Most, if not all the commentators are with the California Nurses Association and the National Nurses Organizing Committee.

Nurses, whether they're aligned with the American Nurses Association or the NNOC or SEIU are foot soldiers, sergeants and include a few generals the the battle for universal health care. It's doubtful we can get there without their help. All their help. So it's sad to see the division between the unions. Shades of Hilary and Barack.

We're not as smart: A Catholic editorial

2008-06-02T11:50:00.000-07:00

The Diocese of Davenport's newspaper, The Catholic Messenger, has this editorial by Frank Wessling on healthcare:

We are not as smart as they are. And we’re not as kind, not as compassionate. But in this case, it’s OK — or at least there’s nothing we can do about it.

Who is smarter and more compassionate? Practically all other people living in modern industrialized societies.

How do we know that? Because they are healthier, and it costs them less to be that way than it costs us to be relatively sicker. And because, even though we know those facts, we do nothing to effectively change the situation.

It gets worse. Other nations operate at a higher moral level when they ensure that everyone, including the poorest, has access to medical care when needed.

Health care is a basic right that should come with modern civilization. The Catholic Church came to that conclusion long ago. Popes began teaching that in the 20th century. Our bishops have taught it repeatedly, especially in national election years when attention is focused on critical issues of our national life.

Yet we Catholics are still little different from other Americans in accepting the deficient — practically and morally deficient — situation that exists.

Health care for us is subject to the pressures of a highly competitive economy, with the result that there are winners and losers. Among the losers are the estimated 47 million Americans without insurance; those who avoid needed care because of high co-payments and deductibles required, those who can’t look for a better job to support their families because they fear the loss of health insurance and businesses hurt by the higher cost of health insurance as compared with foreign competition. In looking at the causes of death in this country, it has been estimated that 18,000 people die each year from the effects of no health insurance or underinsurance.

In the United States, 16 percent of gross domestic product goes for our fragmented health care system while other developed nations generally spend less than 10 percent. And their people are healthier by almost every measure, they live longer and their infant mortality is lower.

Surely we can do better.

Sister Carol Keehan, a Daughter of Charity who is president of the Catholic Health Association, laid out all of this in a May 16 speech to the City Club of Cleveland, Ohio. She called it “a very ugly picture,” and made this observation:

“In no other area that I am aware of do Americans believe that other nations are smarter or more compassionate than we are. If they can do it, it seems to me that we ought to believe we can do it as well.”

Indeed.

The American bishops' silence on this issue has been shameful. For them to adopt as vigorous a stance on this as they've had on that other healthcare issue would do much to restore their credibility with the rest of us.

Geography & healthcare

2008-06-02T11:17:00.000-07:00

Consumer Reports has published an article on the Dartmouth Atlas of Health Care - a wonderful thing. Consumer Reports is really on a tear about healthcare, and this article provides our friends and neighbors information about a big part of what's wrong with U.S. healthcare.

Because physicians are paid on a fee-for-procedure, cost-plus basis, the incentives are to do more procedures, rather than just the right procedures. Physicians and nurses are generally ethical people, but they're just human. Add the need to pay for that MRI machine to the old lady's son insisting on "Do whatever's necessary, doc," and you end up with unnecessarily aggressive treatments - something proven out by the crazy regional differences on how many procedures patients are getting some places - without better outcomes.

Geography and health care
The amount of medical care that people get for serious illnesses varies enormously from place to place. In the last two years of life, the average patient spent 11 days in the hospital in Bend, Ore., and 35 days in Manhattan. In those same two years, patients visited the doctor an average of 34 times in Ogden, Utah, and 109 times in Los Angeles.

The Dartmouth Atlas based those findings on the Medicare claims records of millions of patients who died from (in order of prevalence) congestive heart failure, chronic pulmonary (lung) disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular (circulatory) disease, diabetes with organ damage, and severe chronic liver disease. Together those ailments account for about 90 percent of deaths of people older than 65.

Over the years, Dartmouth research has yielded some startling insights:
The local supply of doctors and hospitals has more influence on the amount and type of care that patients receive than their actual medical conditions have. The more medical resources a region has, the more aggressive the treatments are.
In the regions that deliver the most care, patients have a slightly higher death rate than patients with the same conditions treated in areas that treat less aggressively.
Patients treated most aggressively are no more satisfied with their care.
The cost differences are vast. Average Medicare spending over the last two years of life for all hospitals ranged from a high of $81,143 in Manhattan to a low of $29,116 in Dubuque, Iowa.

So the Dartmouth folks are big on best practices, as are other medical systems that keep down healthcare costs - and simultaneously maintain good access. (Note in the Consumer Reports' articles that "Patients in the high-spending, aggressive-care regions waited longer in emergency rooms and doctors' offices than patients in lower-spending regions did.")

Linda Gorman, from the libertarian Independence Institute and a commissioner on Colorado's Blue Ribbon Commission for Health Care Reform, was always vehemently against "best practices." She argued that the science was too soft, that it was subjective, that by God if a patient wants bad care then it's their right to get it - or something along those lines.

These are folks who also consider the science behind global warming to be a bunch of hooey. I don't know whether they also think the moon landing was a hoax.

Part of progress - and survival - comes from measuring cause and effects and paying attention to the answers. Dartmouth has come up with some pretty good answers here - information that's important whether we get a healthcare system or remain stuck with laissez-faire, for-profit healthcare. If we had a healthcare system, we could move more quickly and surely with this information towards more efficient and humane standards. Until that day, we'll muddle through and probably get partway there. Or not.

Colorado & healthcare reform

2008-05-30T14:45:00.000-07:00

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!

2008-05-30T12:20:00.000-07:00

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

2008-05-30T08:36:00.000-07:00

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).

Coincidence? I think not...

2008-05-29T05:37:00.000-07:00

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.

Put a Doctor in the House!

2008-05-26T18:56:00.000-07:00

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?

2008-05-26T18:34:00.000-07:00

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.

Time predicts healthcare reform

2008-05-22T20:54:00.000-07:00

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

2008-05-22T20:31:00.000-07:00

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

2008-05-22T20:07:00.000-07:00

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

2008-05-22T19:57:00.000-07:00

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

2008-05-22T13:32:00.000-07:00

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.

#30#

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."

The Kennedys and faith

2008-05-21T08:09:00.000-07:00

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.

Surfing dolphins

2008-05-16T14:47:00.000-07:00

Reform: it's about economics

2008-05-16T14:29:00.000-07:00

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

2008-05-16T14:03:00.000-07:00

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

2008-05-15T08:42:00.000-07:00

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

2008-05-15T08:14:00.000-07:00

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

2008-05-14T16:59:00.000-07:00

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

2008-05-14T07:26:00.000-07:00

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

2008-05-13T15:53:00.000-07:00

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

2008-05-09T10:33:00.000-07:00

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

2008-05-09T09:52:00.000-07:00

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.

Health care rally at Denver capitol

2008-03-03T19:23:00.000-08:00

The AP had interesting coverage of the rally today.

Dozens rally for health care at state Capitol

Associated Press - March 3, 2008 4:34 PM ET

DENVER (AP) - Health-care advocates are asking Colorado lawmakers not to wait for the federal government to find a way to insure 790,000 residents who don't have coverage.

Dozens of people rallied at the Capitol Monday urging the Legislature to act.

Governor Bill Ritter has made health coverage a priority but is rejecting demands to support a single-payer plan.

He says Colorado needs a slower approach that is affordable and that helps control costs.

Ritter's initial $25 million plan would cover about a quarter Colorado's uninsured residents.

The plan calls for expanding children's health coverage, creating a center for improving value in health care and helping consumers find the best insurance.

Ritter's plan won't cover a quarter of Colorado's uninsured.

I didn't hear demands for him to support single-payer, and I didn't hear him reject single-payer.

Nader as a (damaged) single-payer mirror

2008-03-03T18:54:00.000-08:00

Slate's Timothy Noah wants people to lay off Ralph Nader.

Fine.

I actually haven't heard much about Nader in recent weeks. There was the wince and shake of the head when I heard he was running, maybe one cynical comment from CLJ, and that was it. OK. I guess I did also wonder aloud how much the Republicans had paid him in order to get him to run again.

We've mostly gotten over Nader. We're part of that common wisdom that sees Nader as part of the reason that Gore didn't win in 2000, yes. Along with blatant cheating on the part of the Bushies, and a disinclination on Gore's part to fight as dirty.

And because Gore didn't win, we got an addled born-again wannabe cowboy for a president who didn't pay attention to frantic warnings that we were about to be attacked. 9/11 happened and the Bushies immediately used the tragedy to their partisan advantage, whipping up fear and using it to get questionable legislation passed. Worse, they played off it to put us in a pointless war that has killed hundreds of thousands of people.

It is impossible to say whether 9/11 would have happened if Gore were president. It is possible to say that Bush wasn't paying attention and did not raise the alert level as Richard Clark and so many others advised. It is also reasonable to suppose that Gore would not have chosen to take us into Iraq.

So thanks, Ralph.

It wouldn't have come to mind except that Nader's running again. Even then, had he acknowledged that yes, turns out there is a difference between Republicans and Democrats, we could have seen him in a better light. It would also help for him to be able to see that he did play a role in the 2000 debacle.

Noah differs.

In the current election, Nader is the sole presidential candidate you're likely to hear about (now that Dennis Kucinich has dropped out) who stands forthrightly for adopting a single-payer solution to the health-care crisis, a stance universally regarded as politically impractical. But single payer is the only solution of much practical value in the real world, as evidenced by the experience of nearly all advanced democracies. If Nader does no more in the 2008 election than oblige major-party candidates to consider that stubborn reality for five minutes, he'll have done us all a big favor.

OK.

Snow in Denver

2008-03-02T16:39:00.001-08:00

Your premiums pay for their lobbying

2008-03-02T16:33:00.000-08:00

This came from Colorado State Rep. Morgan Carroll's office:

POLICY CORNER

THE COST OF HEALTH CARE - LOBBYING IN HEALTH CARE

From 1998 - 2007 here’s how much the following industries spent on lobbying activities nationally:

Insurance Industry spent $1,008,474,967 on lobbying
Pharmaceutical Industry spent $1,316,714,703 on Lobbying
Hospital / Nursing Home Industry spent $563,926,474 on Lobbying
Health Professionals spent $531,096,203 on Lobbying

*SOURCE: Open Secrets.org
*SOURCE: Kaiser Family Foundation

Rep. Carroll notes that the consumer is ultimately footing a big bill for lobbying activities that are not always in their best interests.

Insurance Adds Negative Value

2008-02-14T11:35:00.000-08:00

Ezra Klein has a nice post beginning with the proposition that the health insurance industry adds negative value to health care -- that is, they make it worse. For those conservatives who go on about how competition always makes things better, he offers, "Competition among drug dealers does not aid the neighborhood, and currently, competition among insurers does not aid the ill. Indeed, their inattention to actual care is startling."

Bravo.

Barry Keene, a businessman who is vice-president of Health Care for All Colorado, often sounds sincerely sympathetic to the plight of the insurance industry -- something with which I can't quite empathize, although I understand the argument. Ezra puts it like this:

It is actually counterproductive for insurers to compete on giving us the best care. It's not simply that they're not doing it, but given the structure of the marketplace, they shouldn't do it. Imagine insurer X creates the best damn diabetes protocols in the country. And they begin advertising this fact. What happens on Day Two? Well, they're flooded with individuals suffering from diabetes, or individuals who fear they will one day be suffering from diabetes. These people, in the current system, are a bad deal. Not only is it near impossible to insure them at a profit, but pooling their costs (which is what insurers do, after all) raises premiums for all the insurer's other customers. When the average customer of an insurer gets sicker, prices go up for all their customers. So the healthy folks contracting with that insurer quit the pool, and go find a cheaper deal, which forces the insurer to raise premiums again, driving out more healthy folks, which forces them to raise premiums again, which drives out more healthy folks, and so on. It's what we call an insurance death spiral, and it ends with the collapse of the insurer.

Risk Equalization in Eire

2008-02-14T07:21:00.000-08:00

For Americans, reading about "risk equalisation" in the Irish insurance market can only evoke a snort of disbelief. It's a concept so foreign I'm not even going to Americanize the spelling.

So what the bloody hell is "risk equalisation" you ask?

According to Medical News Today, risk equalisation is how competition in the health insurance market works to the benefit of all health insurance subscribers. It operates alongside community rating, open enrollment and lifetime cover. Here are the definitions:

Open Enrollment entitles persons of all ages, irrespective of health status to avail of health insurance.
Community Rating ensures that younger and older subscribers pay the same amount for similar health insurance cover and that subscribers pay the same amount for similar cover throughout their lives. This means that people can continue to afford health insurance right into those decades of their lives when they are most likely to need it.
Risk equalisation payments involve transferring funds from insurance companies which have a disproportionate share of young, healthy subscribers to companies which have a disproportionate share of older people who are more prone to illness.

Crazy.

"This allows for an equitable market, enabling companies to compete on a equal basis, but also protecting customers through removing the incentive to engage in preferred risk selection," according to the story.

Crazy.

This would protect individuals and families at the cost of profit. It's nuts. Probably communist.

Most EU countries have supplemental insurance that a lot of people buy -- about 50 percent in Ireland. (And yes! Those private insurance costs are factored into the total costs you read about where the U.S. looks so bad.) Evidently the EU court doesn't want to model their insurance market on ours. Odd, eh? Ours is so robust. Very profitable industry.

No doubt the insurance industry will continue its assaults on the notion of protecting the consumer in this wild-eyed manner. Sooner or later, by hook or by crook, "risk equalisation" will be a boogey-man of the past.

Two Kinds of Health Reformers

2008-02-13T14:19:00.000-08:00

Brad Warthen says this well:

We continue to concentrate on the wrong thing -- getting the uninsured into the present system -- when we talk about health care reform.

Increasingly, those of us who are privileged to be in the system find that we can't afford health care, either. The whole system is rotten, wasteful, too expensive and too inefficient. We pay more money to be sicker than folks in any other advanced nation.

There are a lot of problems with our system, but the biggest is the basic premise -- employer-based health care through for-profit (and we're talking for HUGE profits) private insurance companies.

If private health care coverage weren't so expensive for all of us, the 1 in 7 who remain uncovered would be in it. But it is, and will be, expensive by definition. A profit has to be made.

A single-payer system is the logical way to go.

So what kind of health reformer are you? The kind who is trying to get the uninsured into the system, or the kind that is trying to change the system? Mother Teresa or Archbishop Romero? Charity or justice?

My Next Life

2008-02-13T09:48:00.000-08:00

Kevin Drum posts Friday cat pictures. Maybe I'll start posting Wednesday sailing pictures.

Denver Post vs. the Governor

2008-02-13T09:05:00.000-08:00

What is it with the Denver Post and Colorado Governor Bill Ritter?

I'm even seeing this when I basically agree with the criticism. Today it's a good health care story about a 53-year-old guy with seizure disorder who can't get insurance. Me, basically, except I've managed to keep my coverage.

Cover Colorado said they'd insure the guy for $500 a month. Only $100 more than I pay. The one private insurer who agree to take him on had a plan that cost $650. Pretty standard, if you're talking about decent coverage for someone with pre-existing conditions. And how many of us reach 50 without a few?

Katy Human, their health care reporter, writes:

While some Coloradans can't afford health insurance and others have inadequate coverage, Sullivan falls into another problem group — people who are generally healthy and middle-class but can't easily get insurance because of pre-existing medical conditions.

Colorado lawmakers, who promised last year to make health reform a priority this session, are rapidly backing off health-reform ideas after realizing it would cost roughly $1 billion to get insurance to the state's 790,000 people without it.

She didn't mention the fact that Health Care for All Colorado's plan would save the state $1.4 billion annually, and that people like this guy with the seizure disorder would be covered -- but again: Pretty standard fare.

Then comes this quote that provides the pullquote and jump tag that the paper uses. It's from the guy's wife:

"When a government cannot respond to the needs of the people, then there is a real problem," Patty Sullivan said Tuesday. "Gov. Ritter is not our friend on this."

What? It's a great quote, and I agree with the basic premise -- politicians are not providing the leadership that they could on this. Ritter himself told me in front of a crowd that the time isn't right, that the pols need us to do more educating. Standard fare, fair enough. Probably even right by many measures.

So on the one hand, I agree that the governor, as the highest elected official in the state has a special responsibility to lead. On the other hand, the Post really viciously attacked Ritter for his support of unions. So I wonder.

Ritter has a press conference today on health care. He referenced cost-shifting the other night on a public television call-in show, a misleading diversion from real solutions. Reducing cost-shifting due to the uninsured has very little potential for saving money under health insurance mandate schemes. If Ritter goes in that direction it would be a great disappointment.

The last part of Human's article was great. It referenced the phased approach to single-payer that Rep. Claire Levy of Boulder hopes to introduce.

Sullivan said she's pinning hope on the few state lawmakers still interested in universal coverage, including Rep. Claire Levy, a Democrat representing parts of Clear Creek, Gilpin and Boulder counties.

Levy said she is looking to introduce a late bill to start building a universal health insurance system in the state by creating an agency to draw up a benefit package and calculate costs.

Eventually, a single-payer system would probably need voter approval.

Startup costs could be high, as much as $15 billion by one estimate, though a nonprofit insurance program would lead to savings for most Colorado families, businesses and health care providers, Levy said.

"I keep hearing people repeat as if it's a received truth that the voters won't pass it," Levy said. "But I hear the same people saying they support a single-payer system. And businesses — especially small businesses."

Imagine No Insurance Industry

2008-02-13T06:40:00.000-08:00

It's easy if you try.

Kevin Drum has a fabulous post at Washington Post on living without the insurance industry. One of the reasons that both Kevin Drum and Ezra Klein are so great is the quality of the comments they inspire. Scroll down and admire how smart people are.

Drum links to an LA Times article on Blue Cross/Blue Shield sending a threatening letter to physicians, telling them they'd better tell all about their patients' conditions so that the insurer can deny treatment by any means possible.

He asks -- what good are insurance companies? "They cherry pick clients, add huge administrative costs to the system, and do nothing to drive innovation or bring down costs."

Next he muses on a column by right-winger Tyler Cohen, who thinks that all we need to do is set up a massive new federal bureaucracy forcing the insurance industry to be more accountable. Drum's responds,

But if it's price signals and competition you're after, why not cut out the middleman and have consumers pay doctors directly? For example, imagine a national healthcare plan that paid 75% of all medical expenses but required you to pay the other 25%. Your maximum out-of-pocket expense each year would be capped at, say, 5% of income at low income levels, 15% in the middle, 30% at the next level, and 50% for the rich. Or something like that. It covers everyone, it limits catastrophic medical expenses, and it eliminates insurance companies and their bloated administration costs. But the copay is high enough that it gives consumers an incentive to shop around and doctors an incentive to compete.

This kind of single-payer system obviously requires lots of government funding, but on the regulatory front would probably be more conducive to competition and innovation than desperately trying to bring down ever-bigger hammers on private insurance companies who are gaming the system. And since the government would basically just be in the check writing business, not the spending business, deadweight costs would be fairly low.

I didn't have to go far before finding a commenter pointing out that high deductibles are counter productive to preventive care.

The internet is a wonderful place. Thanks Al Gore.

Canadian urban legends and realities

2008-02-09T13:19:00.000-08:00

Every single-payer supporter should take a look at the Urban Legends Reference page on an email that purports to be from a Canadian talking about the problems with the health care system there.

[from the inaccurate viral email]What they don't tell you is how much we pay in taxes to keep the health care system afloat. I am personally in the 55% tax bracket. Yes 55% of my earnings go to taxes.

[in reality...]The highest federal income tax rate in Canada is 29% (for persons with annual taxable income over $120,887), and the highest provincial income tax rate in British Columbia is 14.7% (for those with annual taxable incomes over over $95,909). The typical upper-income level Canadian taxpayer is not in a 55% tax bracket.

By way of comparison, a typical upper-income level American taxpayer residing in California pays a roughly equivalent share of his income in federal and state taxes, even though the U.S. has no national health insurance program.

On the other hand, the Canadian system is not perfect. There are waits, and in a recent Commonwealth Fund report, Canada scored fifth out of six nations in terms of overall system adequacy. (The U.S. came in sixth.)

And so people do have complaints. They rarely take into consideration what the alternative is to guaranteed health care for all, and they get some things just plain wrong, but we need to be aware that Canada is not a panacea. We're not selling snake oil. We're simply arguing for a better way.

U.S. Medicare is already better than Canadian Medicare. There's no reason an expanded U.S. Medicare couldn't also be better.

Mass Gov Looks to Single-Payer

2008-02-09T13:10:00.000-08:00

The Berkshire Eagle reports that regarding Massachusetts' mandated insurance scheme, Governor Deval Patrick says:

"the rate of increase in premiums is a serious problem for the state system and for private individuals, families and businesses as well. . . and there's a view out there that as long as private insurance is a part of health-care reform, we're never really going to break the back of the pattern." He called for serious consideration of a single-payer universal health care solution by the next administration in Washington.

The paper cited a series from the Boston Globe outlining the state's problems with their new system, which forces people to buy private insurance. In particular, the Berkshire paper noted,

Patrick inherited inaccurate assumptions about the cost of state-subsidized health insurance from the Romney administration, which created the program along with Beacon Hill lawmakers. (It's laughable whenever the presidential flunk-out blasts "Hillary Care" as socialized medicine, since it's based largely on "Romney Care.") Patrick's budget proposal for the upcoming fiscal year includes $400 million in extra health care spending — taxpayers would be responsible for nearly half of that, with the federal government counted on to supply the rest.

With the Bush administration now seeking massive cuts in health-care and other non-military spending, the immediate prospect of relief from Washington looks bleak. A McCain presidency would amount to a Bush third term when it comes to domestic spending. A Clinton or Obama administration would produce a sea-change, but it's unlikely the federal government will be in a position to bail out Massachusetts if health care insurance spending spirals out of control.

#

The state program is run by the Commonwealth Connector, which hooks up uninsured residents with the appropriate coverage. Jon Kingsdale, head of the program, told The Globe in no uncertain terms: "This is not sustainable if we don't deal with affordability." Proposed solutions are vague or half-baked at this point, ranging from a $1-per-pack increase in the cigarette tax (a great idea anyway) to help fund the state's health program to plans by a pharmacy chain to put affordable clinics in its stores to deal with basic maladies (a highly-debatable idea). Down the road, tighter regulation of hospital fees and insurance rates may have to be considered.

To put it simply, unless and until the cost of health care — much of it administrative, tied to the bureaucratic jungle of dealing with private insurance carriers — is contained and reduced, the Massachusetts reform program is in jeopardy. And this would bode ill for any universal health care program, with or without mandates, nationwide.

Polish lobbyists call for private insurance

2008-02-09T13:05:00.000-08:00

The Polish Insurance Chamber is calling for private insurance that would compete with their government programs. They say, "The PIU assumes the cost of the additional health insurance would be around zł.50 per month. Assuming a take-up of 15%, this would mean an extra zł.3.5 billion for the Polish healthcare system."

If the system is underfunded, wouldn't an increase in taxes do that more efficiently?

Already on Our Way

2008-02-09T12:53:00.000-08:00

The libertarians are right about one thing -- we already are well on our well to universal health care. When you add up the veterans, active duty military, government employees, the elderly, the incarcerated, the poor on Medicaid, the disabled, etc., a large percentage of U.S. citizens do already receive health care paid for by the government.

This writer from an Oklahoma College paper thinks it's 60 percent. I think that figure actually is how much of the $2 trillion price tag is paid for by our tax dollars, not the percentage of people getting care. Remember that 80 percent of the cost is eaten up by the sickest 20 percent of the people -- many of whom are indeed already getting subsidized care.

What we're fighting over is whether the rest of us should not only have to pay for that, but pay through the nose to get substandard coverage for our own families through extortionary private for-profit health insurance.

The Oklahoman writer posits that this is a fiscal and moral crisis -- a good way to put it.

And the sad thing is that we're already paying for universal health care. We're just not getting it.

UAW President Calls for Single-Payer

2008-02-09T12:48:00.000-08:00

Crains Cleveland Business reports that United Auto Workers President Ron Gettelfinger in a speech at the City Club of Cleveland urged the country to adopt a single-payer health care system.

Gettelfinger, president of the 640,000-member union since 2002, said the health care crisis, the lack of a national industrial policy and the need for improved trade agreements are at the top of his agenda.

“We believe health care should be a right, not a privilege for those who can afford it,” he said.

FL's Ben Graber & single-payer

2008-02-09T12:03:00.000-08:00

Ben Graber, MD, is running a sleepy campaign against six-term Democratic Rep. Robert Wexler in Florida. Congressional Quarterly reports that Graber only raised $700 in the last quarter of 2007 -- unlikely to be enough to unseat an incumbent.

His lack as a candidate makes for bitter reading when compared to his good sense in health care reform. In an opinion piece in the Sun Sentinel, Graber writes, "A wise person once said, 'There is nothing as powerful as an idea whose time has come.' A single-payer health plan is that idea."

Here's are his talking points:

Expand Medicare to include people 55 to 64 years old, veterans and the chronically ill.
Eliminate the need for any HMO involvement in regular Medicare by stabilizing premiums. This is accomplished by providing a formula for a much expanded and reduced-risk population.
Offer an affordable premium until age 74 and then freeze the premium at age 75 and beyond.
Enhance the Medicare D program by eliminating the doughnut hole and negotiating with pharmaceutical companies worldwide for a bulk discount on medications.
Remove research and development costs from the price determinator and offer independent U.S. research grants.
Incorporate the Veterans Health Administration into Medicare and Medicaid.
Fund Medicaid premiums for those below the poverty line — 75 percent by the federal government and 25 percent by the states.
Develop Medicare and Medicaid buy-in programs to expand the single-payer system to all ages, including children.
Place premiums for small businesses and individuals on a sliding scale based on the ability to pay.
Change annually based on individual financial circumstances.
Utilize existing infrastructure, saving billions in conversion costs.
Allow insurers to participate, but in a new capacity as facilitators, product enhancers and recruiters.

This phased-in approach may have a better shot than HR676.

Vermont rallies - whoops

2008-02-09T11:42:00.000-08:00

Single-payer supporters in Vermont seem to have lost it, according to the Rutland Herald. This is from a report on single-payer supporters meeting with legislators:

But as the crowd grew more raucous (some began interrupting lawmakers and insulting legislative staff), Rep. Patricia O'Donnell, R-Vernon, staged her own interruption as she came to the front of the room and asked people to treat their lawmakers with respect.

"If you want to be listened to, you have to be respectful," O'Donnell, a member of the House Health Care Committee, told the crowd before a chorus of people yelling "sit down" and "shut up" sent her out of the room, the door slamming behind her.

Maier told the crowd the criticism for legislative staff — who have researched aspects of the hospital plan for lawmakers — is off base. He added that while he doesn't "enjoy being yelled at, it is our job to listen and to ask the tough questions and to dig down."

"If we don't ask these kinds of questions we would be irresponsible," he said. "It's not our job to pass ideas and concepts."

Racine also told the crowd that their anger is misplaced and suggested that attention should also be focused on state and elected officials who do not support universal health care. He cited the new proposed budget from Gov. James Douglas, which he said underfunds Medicaid and will result in "$5 million in new co-pays and price increases" for Vermonters.

"I know the system is not sustainable. It's a national crisis," Racine said. "If some folks have ideas on how to make this work, I'm all ears."

On the opinion page,the editors opined:

In Vermont health care has taken on the feel of an ideological crusade among some supporters of universal care, partly because of the apparent simplicity of their proferred solution and because it is easy to vilify opponents as creatures of self-interest. So they are able to clothe themselves in the robes of virtue and lose sight of who is and isn't working to advance their cause.

Racine and Maier are working to advance their cause. But it is not simple. The bill that was up for discussion would place all hospital costs under the jurisdiction of the state in a step toward a single-payer system. The idea makes some sense, but there are many complications. If the tax hike supporting such a program were not offset by comparable cuts in health care premiums, what would happen? These are not questions to be dismissed lightly, and lawmakers are not less than dedicated to the cause for considering them.

The left is capable of blowing it this year. Self-righteous, ideological posturing is a turn-off to voters and does not encourage intelligent policymaking.

We should not make the mistake of the right-wing, who were so certain they were right they forgot the need to persuade the rest of us, who were pretty darn sure they were dead wrong.

Only about a quarter to a third of the country is pretty darn sure we're wrong. But we can increase that number if we're not careful.

Hell, even if we are careful that number's going to increase, because we've already awakened the giant.

Minnesota Health Plan

2008-02-09T11:32:00.000-08:00

The Bemidji Pioneer reports that Sen. John Marty, a Minnesota state legislator, led a delegation of freshmen legislators to Bemidji to unveil the Minnesota Health Plan, a bill he introduced late last session and which he hopes will be heard this session.

It would create a single-payer system -- or, as the Legislators introducing the bill prefer, a single-administrator plan. A board, set up by the Legislature, would collect premiums from all Minnesotans -- based on ability to pay.

The plan obviously creates savings by centralized billing and by spreading premiums among all Minnesotans. They take pains to explain that the plan is not socialized medicine as providers such as doctors are still private.

Marty outlined the proposal as:

Allowing people to go to the doctor, clinic or hospital of the patient’s choice.
The plan covers all medical needs including prescriptions, mental health care, dental services, chiropractic.
A patient cannot be rejected because of a pre-existing condition.
No deductible or co-payments.
Premiums on individuals and businesses are based on ability to pay.
The plan is administered by a 15-member public board representing the public, not just insurance company executives.
The plan focuses on preventive care and early intervention to keep people healthy and save money.

Marty expects it may take four or five years to make a full change.

Health insurance, he says, is not something we should be selling. It is rather something we should be making sure we all pay into and we all get the service, like we do with police and fire.

Well put.

Harry and Louise in 2008

2008-02-09T11:23:00.000-08:00

Breaking news from the Newark Advocate:

In 1993... The insurance companies and pharmaceutical giants spent millions of dollars on the Harry and Louise ads. These ads featured a married couple discussing the negatives of that system. Think of Barry Bonds discussing the problems of steroids.

Regardless of your politics, I ask you to consider only candidates who want to solve the medical insurance problem in our country. It is the key issue of this campaign.

Oh yeah, it seems Harry suffered from several infirmities and died broke in a nursing facility. Louise was forced to sell all of the couple's assets after a debilitating stroke forced her into a Medicaid-paid care facility.

Mandates To Buy into a Sick System

2008-02-09T11:10:00.000-08:00

Democracy Now has a transcript from their 8 February 2008 show with Juan Gonzalez and Robert Kuttner that includes a transcript from the Obama/Clinton debate that had the spontaneous audience applause for single-payer.

Kuttner makes excellent points on mandates -- "My point is that a mandate, in a situation where the whole system is sick, makes that sickness the problem of the individual. Instead of putting a gun to people’s heads, typically people who can’t afford good quality insurance, and saying to them, “You must, under penalty of law, or pay a tax or pay a fine, go out and find decent insurance,” it’s so much better policy to just have insurance for everybody. Then there’s no question of a mandate.

"I think it’s a very bad position for progressives to back into, because it signals that government is being coercive, rather than government being helpful. Now, we can split hairs and argue whether Obama is being principled or tactical, but I think his discomfort with the idea of a mandate is something that I applaud. I wish that both he and Clinton had gone all the way and said, let’s just to do this right and have national health insurance. I think they could have used this as a teachable moment. They could have bought public opinion around. Medicare is phenomenally popular. Medicare is national health insurance for seniors. Let’s have national health insurance for everybody."

Here's the transcript from the debate:

SEN. HILLARY CLINTON: We cannot get to universal healthcare, which I believe is both a core Democratic value and an imperative for our country, if we don’t do one of three things. Either you can have a single-payer system, or—which I know a lot of people favor, but for many reasons is difficult to achieve—or you can mandate employers—well, that’s also very controversial—or you can do what I am proposing, which is to have shared responsibility.

Now, in Barack’s plan, he very clearly says he will mandate that parents get health insurance for their children. So it’s not that he is against mandatory provisions; it’s that he doesn’t think it would be politically acceptable to require that for everyone. I just disagree with that. I think we, as Democrats, have to be willing to fight for universal healthcare.

SEN. BARACK OBAMA: What they’re struggling with is they can’t afford the healthcare. And so, I emphasize reducing costs. My belief is—is that if we make it affordable, if we provide subsidies to those who can’t afford it, they will buy it. Senator Clinton has a different approach. She believes that we have to force people who don’t have health insurance to buy it, otherwise there will be a lot of people who don’t get it. I don’t see those folks. And I think that it is important for us to recognize that if, in fact, you’re going to mandate the purchase of insurance and it’s not affordable, then there’s going to have to be some enforcement mechanism that the government uses. And they may charge people who already don’t have healthcare fines or have to take it out of their paychecks. And that, I don’t think, is helping those without health insurance. That is a genuine difference.

Amy Goodman points this out: "It’s interesting to note something Hillary Clinton says in that clip. When she mentions a single-payer system, the audience applauds and cheers, even though it’s an option rarely seriously discussed by politicians or the corporate media. And Hillary Clinton acknowledges the applause by saying, “I know a lot of people favor [it], but for many reasons [it’s] difficult to achieve.” She doesn’t explain why she thinks it’s difficult to achieve. And polls repeatedly show a majority of Americans favor it. An A.P. poll in December found nearly two-thirds of voters want universal healthcare, in which everyone’s covered in a Medicare-type program, while more than half of voters explicitly said they support single payer."

Kuttner replied that "one of the reasons that it’s difficult to achieve is the lack of leadership on the part of leaders like Hillary Clinton and, for that matter, Barack Obama. I mean, if you had Hillary Clinton and Barack Obama say, 'You know, this is an intramural debate that we should not be having, this debate about mandates; we should do this right: we should have national health insurance,' public opinion would turn around on a dime. And instead of it being this fringe idea, all of a sudden, just because the two of them had blessed it, it would become a mainstream idea, and we would be having a debate that we should have been having all along."

Amy Goodman is a national treasure.

Al Franken on Single-Payer

2008-02-09T11:07:00.000-08:00

During a Minnesota Public Radio debate, Al Franken said that "states should pick which system works best -- maybe the Clinton plan would work in one state, but single-payer would work well in another."

Coloradoan single-payer - again!

2008-02-08T22:13:00.000-08:00

Fort Collins' is the real deal. The progressive community likes to say that while other progressive places in Colorado (no names...) do a lot of talking, the progressives in Fort Collins actually get things done.

I gotta admit, I see proof of it on a daily basis. Here's yet another single-payer column in The Coloradoan, their paper -- this one by G. Richard Dunn. He writes:

The potential national savings has been confirmed recently at our own state level; the Colorado 208 Health Care Commission report is complete and confirms there could be a major savings in health-care costs for Coloradans. The stated charge to the commission was to make a recommendation of health care for all Coloradans and to reduce health-care costs. The good news is that one of the recommendations does exactly that! The bad news is several politicians have already responded that while it might save our residents money, we need to carefully study the issue because it might raise taxes.

The commission retained an independent cost expert and the expert confirmed that 100 percent of Coloradans, including the 800,000 presently uninsured, could be covered and still enjoy an annual savings of $1.4 billion. The commission has forwarded its findings to the Legislature.

If the Legislature and the governor will read carefully, they will find there was a great deal of public and professional support across the state during the hearings for the "Colorado Health Services Plan (single payer)."

True. The 208 Commission held hearings across the state, and they heard again and again from single-payer supporters. Some of the commissioners -- and Colorado pols -- thought that Health Care for All Colorado must have sabotaged the hearings, filling them with our members.

In fact, we'd never heard of most of the people who showed up. There's a groundswell of support for single-payer, not just in Colorado but across the country.

I'd say it's past time for the insurance industry to bring out their big guns, and start running ads on how horrible health care is outside the U.S. They seem to be counting on the Democratic politicians to bring about mandates for people to buy their crappy product. They may be reassessing that now that it's failed in California.

ABX 1 1 Favored Insurance Industry

2008-02-08T21:58:00.000-08:00

California State Senator Leland Y. Yee, whose constituents live in San Francisco and San Mateo counties, wrote to the San Francisco Chronicle on why he didn't support Gov. Schwarzenegger's health reform bill -- which would have forced Californians to either buy health insurance or face the loss of their homes and the garnishing of their wages.

Now it's true that already happens to people once they get sick or injured in the United States, but this would have brought it on even sooner.

This bill was not a step in the right direction, but a huge jump backward for working families who lack health care. As a co-author of the true universal health care bill, Senate Bill 840, I opposed AB X1 1 because it would have required consumers to buy their policies regardless of the cost. Under AB X1 1, all Californians would have been required to buy insurance with no caps on premiums, no regulation of the costs of insurance or medical expenses, no maximum deductibles, and no clearly defined minimum coverage...

The most objectionable part of this proposal was that if an individual did not purchase insurance within 62 days of the enactment of this flawed legislation, then the Franchise Tax Board would have been authorized to collect premiums by garnishment of wages or mortgage liens on the property of working Californians...

Such an experiment is under way in the Commonwealth of Massachusetts with troubling results. Already the Commonwealth's budget is being strained by the unanticipated costs of the mandated insurance program. Over the next few years, Massachusetts lawmakers will be forced to divert hundreds of millions of dollars out of the general fund to subsidize a program that was supposed to pay for itself, taking scarce funds away from other critical programs. While this is happening, Massachusetts residents who have not or cannot comply with the mandate to buy costly insurance on the open market are being forced to pay hefty fines, further compromising their ability to meet the requirements of the law.

I hope Colorado legislators are taking note.

Mandates Do Not Equal Universal Coverage

2008-02-07T11:42:00.000-08:00

There's a well reasoned piece by RJ Eskow at Huffington Post on mandates. He points out the maddening nature of Clinton claiming that Obama's health plan isn't universal because it doesn't include mandates.

A lot of good progressive people are fooled on this. Particularly galling was the woman who wrote in some place to express her dismay over not being able to vote for Obama because she was in favor of universal health care. Geez. Eskow points out that the Massachusetts' plan is more "mirage than miracle," and that "the plan will leave 20% of that state's uninsured without coverage, and the real number may be higher. Why? Because there is a wide band of people who would suffer financial hardship if compelled to pay the premiums, and it's financially infeasible to subsidize them all."

And look at what mandates might do to a family of four. While Clinton won't tell us the percentage of income she'd tie to mandates, many analysts have been using 10%. If premium assistance is provided up to 300% of the poverty level, a family of four trying to survive on $75,000 could be forced to pay $7,500 to insurance companies or in health copayments. The alternative could be tax penalties or garnished wages. That's profoundly unfair. I also believe it's a serious misread of American political culture to think that kind of mandate could ever get through the legislative process....

Adding 10% to struggling families' financial burdens is nothing more than a highly regressive tax to be paid to wealthy insurance companies, which is why insurance companies prefer the Clinton plan.

J. Jonik's view

2008-02-07T09:53:00.001-08:00

This is one way to think about mandates. I love the smiley face on the wing.

Agreeing with the WSJ

2008-02-07T09:16:00.000-08:00

This is a bit scary.

There is a part of me that is pretty sure that if the Wall Street Journal's certifiably malicious editorial page is against it, I'm for it.

On the other hand, I know for certain that it's wrong to garnish someone's wages or impose liens on their mortgage to force them to pay for private insurance.

The WSJ's article, misleadingly titled "Saying No to CoerciveCare" (that should be "Saying No to Coercive Private Insurance") noted that labor unions launched the last minute revolt against the mandates in California Gov. Schwarzenegger's plan and caused its downfall -- 7-1 in committee.

This defeat has national political implications. Hillary Clinton, for example, has denounced Barack Obama for refusing to include an individual mandate in his health-care plan. Yet many California unions argued that a mandate would force uninsured, middle-income working families to divert money from more pressing needs toward coverage whose price and quality they cannot control.

I'm no economist (but I'm married to one, something that leads to many, many conversations on true costs and the need for marketplace transparency, as well as mini-lectures on fixed vs. variable costs, and other truly boring matters) but the WSJ author seems to be making a leap to claim that health insurance costs have gone up in Massachusetts mandates because of heavy regulation and increased demand. Insurance costs are supposed to go down when you increase the risk pool, as supposedly happens with mandates. That's because suddenly all the healthy free riders who before had gambled that they weren't going to get sick are paying into the system. More money in the system, fewer claims per capita (because those folks are indeed healthy) and voila, costs per capita go down. Except they didn't.

The author instead seems to be suggesting that costs for health insurance would go up with increased demand in the same way that costs for a rare but suddenly popular dog breed would go up after everyone realized they wanted one.

No surprise to hear that regulations are also blamed. Those are the regulations that say that health insurers have to actually give some value for the money -- that they have to give a percentage of the value, for instance, that people in France get for their health dollars spent.

It's also no surprise that the private insurance industry cannot in fact give that kind of value for the dollars we pay them. Unless you're a shareholder or CEO. Good value received per share in that case.

The cost of health insurance went up 12 percent last year in Massachusetts -- twice the national average.

No one is escaping the financial sting. The state health-care bill for fiscal 2008-2009 is expected to touch $400 million -- 85% more than originally projected. Still the state won't be able to fully shield those it subsidizes from the premium increases. But uninsured folks who don't qualify for government help really get pounded. Before the hike, the cheapest plan for uninsured couples in their 50s cost $8,200 annually. Now, unless government bureaucrats hand them an exemption, they might well find it cheaper to pay the penalty -- up to half the price of a standard policy -- than purchase insurance. That is, pay to remain uninsured. This is legalized extortion: TonySopranoCare.

The government response to rising premiums is, unsurprisingly, price controls. The Commonwealth Health Insurance Connector Authority -- the bureaucracy created to oversee RomneyCare -- is considering prohibiting underwriters from raising premiums more than 5% for unsubsidized plans, meanwhile requiring them to cover 40-odd benefits from hair prostheses to chiropractic services. If companies can't scale back coverage, they'll have to compromise care; and the Connector is perfectly willing to assist.

As reported in the Boston Globe, the Connector is encouraging insurance companies to include only a limited network of cheaper physicians and facilities in some plans to hold down premiums. Patients who wish to see more expensive providers will have to dig into their own pockets. Dr. Steffie Wollhandler, a professor of medicine at Harvard University, worries that the Connector will revive Gov. Romney's original idea of enrolling poor people in plans that only offer access to neighborhood health centers ill-equipped to treat anything beyond routine ailments. Forcing people to buy substandard care they cannot afford is not universal care, she says. "It is a hoax." And so Massachusetts is marching toward a system of two-tiered medicine -- the alleged market inequity that universal care is supposed to cure.

Imagine that. Steffie Wollhandler approvingly quoted in the Wall Street Journal.

Greeley Tribune on single-payer

2008-02-07T05:28:00.000-08:00

The Greeley Tribune has published a wonderful piece by Tom Linnell on single-payer. He begins,

I am starting to see why all of us -- liberals, conservatives, and independents -- might really like single-payer health insurance. Here are some principles that I believe most of us can agree on: 1) the least possible amount of government involvement in our lives, 2) efficient delivery of services and, 3) freedom of choice for individuals.

Bravo!

Clinton Won't Discuss Penalties

2008-02-07T05:24:00.000-08:00

The NYTimes reports that in discussing her health care plan that includes forcing people to buy private health insurance:

When asked for a third time whether garnishing people’s wages was an option, Clinton told Stephanopoulos: "George, we will have an enforcement mechanism, whether it's that or it's some other mechanism through the tax system or automatic enrollments." She went on to say that enforcement of her mandate was less important than the fact that her plan requires all citizens to have coverage, while her rival, Senator Barack Obama of Illinois, would only require children to be covered, according to the article.

The issue of health care mandates has become a central topic in the Democratic primary contest because it represents "one of the few substantive differences" between Clinton and Obama, reports the Times. Clinton insists that the mandate is key to achieving universal coverage, while Obama argues that the "use of government subsidies to reduce the cost of insurance, would effectively guarantee coverage to anyone who wants it." Some Obama advisors pointed to Massachusetts, which recently implemented an insurance mandate, as an example of a state that has "failed to enroll nearly half of its uninsured despite imposing a modest first-year tax penalty of $219."

Get it in Writing!

2008-02-07T05:14:00.000-08:00

The Boston Globe reports:

In New Haven on Monday, a fourth-year Yale medical student named Liza Goldman approached us excitedly to report on a conversation she had with the New York Senator on the rope line.

According to Goldman, she told Clinton, “I’m sure you know that single-payer would save billions of dollars and thousands of lives.”

Clinton, Goldman says, responded in agreement but said, “It’s not politically feasible.”

So Goldman offered her a hypothetical: “Would you sign it if it came across your desk?”

“She said yes, and shook my hand,” Goldman said.

A Clinton spokesman did not get back to us about whether Clinton remembers the conversation the same way.

Pharmaceutical Ads Since 1997

2008-02-07T05:00:00.000-08:00

Amazing. The FDA only gave its blessings to "direct to consumer" ads for prescription drugs in 1997. Those ads now sponsor our nightly news and pay the production costs of our magazines. That was just 10 years ago -- who paid in 1996?

The LA Times has an opinion piece on how the ads have "fundamentally altered the doctor-patient relationship by forcing physicians to respond to people's demands for heavily touted drugs, rather than taking the initiative in suggesting treatments."

"DTC advertising increases people's awareness of diseases and available treatments," Pharmaceutical Research and Manufacturers of America, an industry group, says on its website. "Studies show DTC advertising brings patients into their doctor's office and starts important doctor-patient conversations about health that might otherwise not have happened."

For example, how many people would have thought to ask about "restless legs syndrome" until pharmaceutical giant GlaxoSmithKline launched a DTC campaign in 2003 to raise awareness of the problem.

Good point. It appears that the industry is now moving to tackle the problem of "excessive sleepiness." They've got something other than a cup of coffee in mind -- and it's not a recommendation to get more sleep...

Need for Vigilance Never Ends

2008-02-07T04:13:00.000-08:00

Last summer I was in a meeting with leaders of Colorado health care organizations. I offered that one of the problems being discussed would not be a problem if the United States had true universal health care through a single-payer system. Actually, most of the problems under discussion weren't problems in most of our peer countries, where there's guaranteed affordable health care for all. A woman who heads a Colorado health care organization, a group nominally for helping people who aren't getting needed medical care, replied sarcastically, "Right, and we'd all be out of a job."

It's possible -- probable, in fact -- that she was joking, and that she simply has really bad timing and judgment.

The fact is that we should all be out of a job, and able to move on to other things. There's lots that needs fixing in this world, if that's our passion.

And in any case, as a story on Medical News Today points out, you can't ever fix anything once and for all, any more than you can clean the kitchen once and for all.

The center doesn't hold.

In "Bush Budget Cuts Will Cripple U.S. Teaching Hospitals And Erode Medical Progress," the news links to a press release from the Association of American Medical Colleges.

Cutting indirect medical education (IME) payments by more than 60 percent, combined with other Medicare cuts affecting all hospitals, will have devastating results. Millions of Medicare patients-as well as the uninsured, the disabled, and the severely ill-rely on teaching hospitals for health care and community services. Such unprecedented cuts to these institutions will endanger their ability to provide the full spectrum of patient care and treatment, erode their fragile trauma and emergency services, and impede the progress they have made in advancing the health of all Americans through education and medical research.

Bush has said that we have universal health care because, he says, people can always go to a hospital to be treated. Evidently he wants to put a stop to that.

In the earlier days of Bush, my husband used to ask the conservative business people with whom he worked to name something that Bush had done competently. The Bush supporters could never come up with anything.

(At this point, I suppose if you were set on judicial activism -- finding more judges who would elect illegitimate presidents, for instance, always side with corporate interests, not concern themselves with personal freedom, etc. -- a person might say that Bush has done a whiz bang job of appointing Supreme Court justices...)

In any case, because it's always easier to destroy than to build, there will always be the need for health care advocates. There were in Britain during and after Margaret Thatcher -- and now, because that country is facing a lobbying assault of privatizing interests.

Canada has groups to save their popular Medicare system.

We'll still need advocacy groups. Not to worry about your job.

Are Mormons Christian?

2008-02-06T09:12:00.000-08:00

Are Mormons Christians?

I've heard my favorite literate priest explain how come not, in theological terms, but it seems pretty academic, doesn't it? After all, as far as I can tell, most Christians aren’t Christians. That's something that becomes even more clear once you begin advocating for guaranteed health care.

It's a cliche but worth repeating: How many Christians today would have anything to do with Christ? Some outcast figure who surrounded himself with poor people, prostitutes, and tax collectors? Some guy who argued against wealth creation, who told people to leave it all behind, and go follow him to some commune or something! The megachurch and born-agains think they’d know Jesus, but I have yet to be convinced.

The thing is, see, Jesus wouldn't have that halo -- the kind Bush sometimes wears. Karl Rove, the master, realized that if you put your guy in front of a circular, golden image, and then told the photogs where they could shoot from, you’d be sure to end up with a couple halo shots. Put that together with the fact that Bush himself believes that God fixed it so he could be president, and of course that chat between him and God about invading Iraq, and voila. You've got some pretty strong indications that someone more powerful than Florida voters wanted this man to be our decider.

I talked with a woman a month ago who was just back from missionary work in the Philippines. She believed that Bush was president because of divine providence. She thinks it might have been in order to make things so bad we'd all wake up.

Thanks, God. Back atcha.

Caucuses and Shame

2008-02-05T20:48:00.000-08:00

I went to my precinct caucus tonight, resolution for single-payer in hand.

I walked away pondering how we can use people's unwillingness to be seen as uncaring to our advantage.

The caucus took place in the cafeteria of my old high school in southeast suburban Denver. Back then, I attended on Tuesdays, Thursdays, and every other Friday. Honestly. I never would have gotten that diploma had I faced the attendance requirements my children faced. Back when I was in school the administration had the option of graduating kids just to get 'em out.

Tonight a crunchy, dry snow covered the roads -- enough to provide a good excuse to anyone who hadn't really wanted to go. We got there about a quarter til, and the parking lots were already filled. It's a suburban school, so there are plenty of parking lots.

There were about 10 precincts, 600 - 700 people in the cafeteria. It was hot, crowded and noisy. At 40, we were one of the smaller precincts. I passed out copies of the resolution to the various tables, explaining that we'd be voting on it later.

We moved through the straw polling, delegate selection and other business, and some of the people melted away. I've been sick but did my best to shout out why we were pushing this resolution -- the only one considered by this somewhat apolitical crowd. I explained that single-payer was already part of the state platform, but not explicitly. I read the HCAC resolution --

"The current health care system in the United States has reached crisis point. The fragmented, administratively wasteful model of commercial health care costs and bureaucratic nightmares for health care providers, patients and employers. Therefore, as a matter of basic economics and the common good, the Denver County Party supports guaranteed, quality, affordable health care for all through a single-payer financed system..."

And so on. We voted -- first for it, then against.

No one raised their hand against it. No one.

But afterwards I learned that someone had muttered, "Right, and who'll pay for it?"

But they didn't openly vote against it.

What if it had been a curtained booth, though? How often do we vote against the common good when there's a curtain there? I did it once. I'm usually a reliable vote for increased taxes when it's for the cause of civilization, but on that election day, for some reason, I was feeling churlish. I still remember it. I wouldn't have done it if it had been visible. It felt like I'd slipped a five out of the church offering instead of putting one in. Or lit a bank of candles without giving an offering.

The trick is, once that curtain is pulled behind you, it's just between you and God -- or you and the thought of your grandchildren's future. What kind of country will we leave them?

Of course, fortunately, single-payer actually means it's less expensive. So it's a fairly easy concern to allay, if a person actually looks into it. But there will always be the folks who don't get the message. And aren't they the same people most tempted when the curtain's closed?

Come to the Rally Tomorrow!

2008-01-30T19:59:00.000-08:00

California Mandate Plan Goes Down

2008-01-30T19:39:00.000-08:00

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

2008-01-30T19:38:00.000-08:00

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

Ech.

More Unions for Single-Payer

2008-01-28T18:41:00.000-08:00

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!

2008-01-28T14:05:00.000-08:00

Faculty Unions Endorse Single-Payer

2008-01-25T12:45:00.000-08:00

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?

2008-01-25T09:21:00.000-08:00

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

2008-01-25T08:51:00.000-08:00

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

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.

Edwards OK with single-payer

2008-01-24T22:14:00.000-08:00

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

2008-01-24T21:52:00.000-08:00

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!

2008-01-24T21:02:00.001-08:00

Gooz on mandates

2008-01-24T15:26:00.000-08:00

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

2008-01-24T15:18:00.000-08:00

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

2008-01-24T14:41:00.000-08:00

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

2008-01-24T14:23:00.000-08:00

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

2008-01-24T13:33:00.000-08:00

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."

Fooled a Couple Times

2008-01-23T16:38:00.000-08:00

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

2008-01-23T09:12:00.001-08:00

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.

Paulie

2008-01-23T09:07:00.000-08:00

Brisbane. What state is that in?

2008-01-23T08:35:00.000-08:00

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.