Ruminations of an Expatriate

Public Health Insurance Will Kill Your Grandmother

Sunday, August 2nd, 2009

Well, that’s almost what the AP reports that “House Republican Leader John Boehner of Ohio said July 23″.

The actual excerpt from the AP “Fact Check: Distortions rife in health care debate” was:

The House bill “may start us down a treacherous path toward government-encouraged euthanasia,” House Republican Leader John Boehner of Ohio said July 23.

Similarly, the AP reports.

Former New York Lt. Gov. Betsy McCaughey said in a July 17 article: “One troubling provision of the House bill compels seniors to submit to a counseling session every five years … about alternatives for end-of-life care.”

To which the AP fact checker responds.

THE FACTS: The bill would require Medicare to pay for advance directive consultations with health care professionals. But it would not require anyone to use the benefit.

Advance directives lay out a patient’s wishes for life-extending measures under various scenarios involving terminal illness, severe brain damage and situations. Patients and their families would consult with health professionals, not government agents, if they used the proposed benefit.

Some opponents to a “public option”, that is, a publicly owned health insurance “risk sharing pool” administered by government, resort to the tried and true, “do you want a bureaucrat making decisions about your health care?”, or something to that effect.

But this is how we make policy in the USA. Those opposed to a particular policy proposal do their best to scare the carp out of the general public of its consequences; lie about the proposal; and, in the case of D.C. ~~lobbying~~ influence peddling firm Bonner and Associates, even forge letters on NAACP and Creciendo Juntos, (“a nonprofit network that tackles issues related to Charlottesville’s Hispanic community”) stationary to send to Congresspersons.

It is sickening, but it’s been that the way throughout the history of our nation, most particularly since corporations were designated as Constitutional “persons” when, in 1886, Chief Justice Morrison R. Waite announced before oral arguments began in the case of Santa Clara County v. Southern Pacific Railroad.

“The court does not wish to hear argument on the question whether the provision in the Fourteenth Amendment to the Constitution, which forbids a State to deny to any person within its jurisdiction the equal protection of the laws, applies to these corporations. We are all of the opinion that it does.”

I apologize for the mini-rant and return to the subject at hand, a publicly owned, not for profit, government administered health insurance risk sharing pool, which private health insurers and the congressional recipients of their financial largesse (congressional whores) realize would eventually put the private insurers out of business, as their necessity for profit, advertising costs, and inflated executive compensations would render them unable to compete with a not for profit system.

The fact is the USA already has a public option, though only seniors are eligible for coverage; and both health care providers and Medicare subscribers are highly satisfied with the system. In fact surveys indicate that Medicare subscribers are more satisfied with their health insurance than those covered by private insurers, as Mark Blumenthal reports.

Those comparisons show the depth of Medicare’s popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their “health plan” a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according to the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.

The Centers for Medicare & Medicaid Services, of the Health and Human Services Dept., surveys health care providers as to their satisfaction with the “contractors” who push paper for Medicare.
Medicare Contractor Provider Satisfaction Survey

Survey Overview
The Centers for Medicare & Medicaid Services (CMS) is launching the fourth national administration of the Medicare Contractor Provider Satisfaction Survey (MCPSS). The MCPSS is designed to gather and report quantifiable data on provider satisfaction with the fee-for-service Contractors who process and pay Medicare claims and provide associated services.

The 2009 MCPSS will query more than 30,000 randomly selected health care providers, targeting Medicare FFS Contractors including Fiscal Intermediaries (FIs)/Part A Medicare Administrative Contractors (MACs); Carriers/Part B MACs; Regional Home Health Intermediaries (RHHIs); and Durable Medical Equipment MACs (DME MACs). Questions will focus on seven Contractor business functions that underlie the provider-contractor relationship: provider outreach and education, provider inquiries, claims processing, appeals, provider enrollment, medical review, and provider audit and reimbursement.
2008 Results

o The national average score across all Contractors was 4.51 (on a 6-point scale, where “1” is “not at all satisfied” and “6” is “completely satisfied”). This was comparable to 2007’s average score of 4.56.
o For the second consecutive year, Contractors’ handling of provider inquiries was the top indicator of satisfaction. This was the third year the function was cited as one of the key predictors of provider satisfaction.

The fact is that, all other aspects of USA health care being equal, the only difference between a publicly owned, not for profit health insurer and a private health insurer is that the publicly owned system costs less, as it would not seek profit, incur advertising expenses, nor pay executives quite so lavishly.

The same “bureaucrats” now working for private insurers would be employed by contractors administering the not for profit system, though probably fewer under a full blown single payer system.

Again, those in Congress owe a Constitutional duty to “promote the general welfare”, which it seems to me enactment of a less expensive, less complicated, more comprehensive, less discriminatory system of health insurance surely would do. Congress owes no Constitutional duty to ensure private profits to those who so generously fill their campaign coffers, except in the interest of securing further contributions with which to further their professional political careers.

I believe that we, as a nation, must establish the principle that health care is a right for everyone and that a system of health insurance should be provided not motivated by profit.

We well know that the profit motive not only encourages innovation and individual industry, but it also drives the amoral amongst us to seek profit at the expense of the greater public good. Some folks, for example, will drive the national economy into the ground for personal profit; some will pay desperately poor folks for a kidney which to sell; some will drive a load of toxic waste down a back road to dump so as to externalize their disposal costs onto the public; or, in the case of private health insurers, do things such as deny coverage for an insured because she neglected in her application for coverage to report she was treated for acne when she was thirteen.

It seems to me that a “health care reform” (it’s really largely health insurance reform) bill will emerge from Congress this year which contains a “public option” and the president will enact the legislation.

Eventually we will have a single payer, not for profit, government administered system of health insurance in the USA and private health insurers, ultimately as a result of their avarice and abuses, will pretty much cease to exist.

What was it that Lenin said about the last capitalist selling the rope with which to hang the last capitalist?

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Seattle Primary Health Care Model

Tuesday, July 7th, 2009

The Reuters reports that a Seattle clinic provides primary care to its subscribers who pay the clinic a fee to subscribe and a monthly fee “depending on age and level of service”. Subscribers buy insurance to cover catastrophic health events.

A Seattle clinic for people fed up with insurance, started by doctors fed up with insurance, has gotten $4 million in private venture capital money to expand, it announced on Monday.

——-

“If you spent five minutes in my office you would notice there is nobody waiting. We don’t have to stack them up like jets over Newark,” said Garrison Bliss, a doctor and co-founder of the primary care clinic.

The new venture funding comes from Second Avenue Partners with participation by New Atlantic Ventures and Clear Fir Partners, bringing total capital raised to about $7.5 million.

Co-founder Norm Wu said per-patient revenue is triple that of insurance-based clinics. He said many costs are fixed so the firm, now losing money, will turn to profit as business grows.

More than 50 noninsurance clinics operate in 18 U.S. states, based on different business models, Wu noted.

The backers believe Qliance can grow very profitable, and the clinic uses stock options to attract new doctors. The next step is to open a suburban office.

Qliance says it is a private alternative to the failures of insurance, which have made health care President Obama’s top legislative priority in Congress, with a price tag of $1 trillion or more.

Qliance customers pay $99 to join, then a flat monthly rate of $39 to $119, depending on age and level of service. Patients can quit without notice and no one is rejected for pre-existing conditions.

Patients must go to outside brokers and qualify medically to buy catastrophic care. One broker said a 30-year-old could expect to pay $133 per month for such care, and a 60-year-old nearly $400, plus substantial deductibles.

Qliance patients get unrestricted round-the-clock primary care access and 30-minute appointments.

“Why would a doctor not want to see sick people? That doesn’t make sense, unless you’re an insurance company,” Bliss said.

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Ain’t It Nice To Have A Coherent, Informed President

Wednesday, July 1st, 2009

An excerpt from the transcript of a town hall meeting President Obama conducted in Annandale, VA.

Q Hi, Mr. President. I’m a member of SEIU and I’m down here in Fairfax County working on Change That Works. What can I do, as a member of the union, to help you with your reform bill?

THE PRESIDENT: Well, I appreciate the question. The most important thing I think the American people can do right now is to just be informed. Tell your friends, tell your neighbors to get informed about what’s happening in the health care system right now. It’s very complicated and I don’t expect everybody to be an expert, but I want everybody to be well enough informed that the scare tactics of those who would oppose reform don’t work.

So when you hear somebody say this is — “Obama is proposing a government takeover of health care” — that’s an old argument that’s been used for years. I just want to be clear. If you’ve got a health care plan that you get through your employer or some other private plan, I want you to keep it. I actually think reforming the system is the most likely way for you to keep the health care that you’ve got. I don’t want to take it over. I think it’s great that you can keep the care that you’ve got.

All I’ve said is I want to make sure that those things that taxpayers are paying for, that we’re getting our money’s worth. I don’t want to provide $177 billion in subsidies to insurance companies. I don’t want to reimburse for five tests when the evidence shows that you just getting one test is going to be better for you because that means that the taxpayers are saving money and I can use that to lower your costs, or to help somebody who doesn’t have health care at all.

I do think we should have a public plan to compete with the private plans. But these private insurance companies, they’re always telling me what a great deal that they give to the American consumer; if it’s such a great deal, why are they worried about competing against the public plan, especially when they say government can’t do anything? (Applause.) [Bold emphasis added].

So they’ll tell you that we’re trying to take over health care. I don’t want to take over health care.

They’ll tell you that we’re going to try to ration the system. We don’t want to get between you and your doctor. What we do believe is that if there’s good evidence out there that shows that the best way to treat your illness is to give you the blue pill, and instead right now you’re getting prescribed the red pill that costs twice as much, I think that you and your doctor, having that information, are probably going to decide to go with the cheaper pill that does just as good of a job, and that will save you money. That’s not rationing. That’s being sensible.

So whenever you start hearing these arguments about socialized medicine, government takeover, rationing, Canada-style health care, what I need you to do — and I need everybody here to do and everybody who’s watching to do — is to actually pay attention to the argument, and don’t let people scare you out of reforming a system that we know is not working.

America — one of the great things about this country is we’ve got a system that’s sometimes kind of hard to change. Congress gets kind of bogged down, and part of that is because of the way the Constitution is designed — it’s served us well because it keeps us very stable. We don’t have coups and all kinds of governments collapsing all the time. But the disadvantage sometimes is, is that it’s hard for us to make big, bold steps. But the great thing about the system is that, every once in a while, when we finally hit a point where things just aren’t working at all, we are able to generate the political will to finally get things done.

That’s how we got Social Security. After the Great Depression, nobody had any pensions or protection, and people started realizing, we can’t have a country where suddenly older Americans are just on the streets, after working hard all their lives. And finally we got Social Security. And then people said, well, we can’t have older Americans who don’t have any health care, and we got Medicare. At every juncture, when we finally need to make a change, we make a change. This is one of those times.

So don’t be scared about the future. Let’s embrace the future. Let’s go after the future. If we do, then I’m confident that we can create a health care system that gives you choice, allows you to keep your doctor, drives down costs, makes sure that every American doesn’t have to worry if they lose or change their jobs. That’s our aim. That’s our goal. We’re going to make it happen this year.

Thank you, everybody. I appreciate you. Thank you. (Applause.)

Incurious George, demonstrably, is incapable of understanding either the forest or remembering the names of the trees in the forest. President Clinton is able to remember the name of every tree in the forest, but doesn’t seem to quite understand the forest as a whole. Obama is able to understand the forest and remember the name of every tree in the forest.

It is all quite remarkable, and refreshing.

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Lack Of Health Insurance Industry Competition

Monday, June 29th, 2009

Those who oppose a publicly administered, not for profit, single payer system of health insurance for the USA or even a “public option” to provide competition to the private insurers, the medical/pharmaceutical/insurance combine, are fond of touting competition in their industries.

Health Care for America Now has release a report addressing competition within the health insurance business. As it turns out, in many areas of the USA there is very little competition.

An excerpt from the Executive Summary.

Executive Summary:
Lack of competition in the insurance marketplace poses unique dangers to consumers. Mergers and industry consolidation have created a situation where a small number of large companies control everything from what they charge to what benefits they offer. A public health insurance option would force private insurance companies to compete – bringing down cost, guaranteeing quality, and setting a benchmark for coverage and transparency.

According to the American Medical Association, 94 percent of insurance markets in the
United States are now highly concentrated.

In the past 13 years, more than 400 corporate mergers have involved health insurers, and a small number of companies now dominate local markets but haven’t delivered on promises of increased efficiency.

Shrinking competition among health insurance companies is a major cause of spiraling
health insurance costs.

Premiums have gone up more than 87 percent, on average, over the past six years.

Insurer consolidation of market share disproportionately disadvantages rural and lower population states.In Hawaii, Rhode Island, Alaska, Vermont, Alabama, Maine, Montana, Wyoming, Arkansas, and Iowa, the two largest health insurers control at least 80 percent of the statewide market.

Growing market consolidation is especially bad for small businesses. The more concentrated the market, the more insurance companies can set prices however they want. Small groups and individuals who buy health plans directly from insurers suffer the greatest increases because it’s as if they buy retail while the larger groups buy wholesale.

Insurers are thriving in the anti-competitive marketplace, raking in enormous profits and paying out huge CEO salaries.

Profits at 10 of the country’s largest publicly traded health insurance companies rose 428 percent from 2000 to 2007 (from $2.4 billion to $12.9 billion). In 2007 alone, the chief executive officers at these companies collected combined total compensation of $118.6 million—an average of $11.9 million each. That is 468 times more than the $25,434 an average American worker made that year.

Industry invests more in buying back its own stock and rewarding its shareholders than in improving system operations, reducing premiums, or in developing ways to pay doctors and hospitals fairly.

Zach Roth, at TPM, has a nice run down on the matter.

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Public v Private Health Insurance

Tuesday, June 16th, 2009

First, I assure you that I am completely appreciative of the virtues of private enterprise; and that, generally, the profit motive and competition provide powerful incentives for innovation, increased productivity, and lower prices. So long as the market is truly free.

I think I’ve observed before that if, for instance, Cubans who work in currently “state” owned enterprises actually owned the enterprise (not necessarily the real property upon which the enterprise operates) and, thus gained from increased business, the enterprises would be cleaner, service would improve, product theft for sale on the black market would drop, and productivity would rise. Such would be a system of real communism, I think, as opposed to the current state capitalist system which reigns in Cuba.

When the free market is impinged, regulation of that market by us, through our government, is required. And sometimes it even serves the general welfare to create a public entity to compete with privately owned enterprises which have continuously ill-served the general welfare. Wasn’t it Adam Smith who long ago observed that markets, economic interactions between individuals pursuing their private interests, do not necessarily operate in the interests of the general welfare; and that it is up to governments to regulate such markets to ensure the general welfare is served?

Such is the case with the USA currently prevailing system of providing health insurance. The system has resulted in the most expensive second rate health care system money can buy.

The USA government was created to serve six Constitutionally established purposes.

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

While it is a duty of the USA government to “promote the general welfare”, it is not the duty of government to guarantee profits to private interests. Our provision to ourselves, through our government, of a system of universal health insurance at the lowest possible cost, it seems to me, clearly falls within the promotion of the general welfare.

Political conditions have never in my life time been more propitious to the creation of a single-payer, publicly owned, not for profit USA health insurance system. Such a system would provide health insurance to all at the least cost, as we the subscribers would pay no profits to shareholders, nothing for advertising, nor inflated executive compensation. A single payer system would reduce administrative costs of medical providers, as they would have but one insurance entity from which to seek compensation, rather than the dozens of private insurers with which they now deal.

The USA citizenry, having for years been economically looted by the private health insurers, has never been more receptive to establishment of a public health insurance option.

Enactment by Congress of a true single payer system, however, is unlikely, as Congress has essentially been bought and sold by medical professionals, health insurers, and pharmaceutical industry representatives. One may visit the OpenSecrets.org, and nose around, to learn of the extent of campaign contributions by such entities.

Current discussions relative to health care reform seem to center, at present, around the question as to whether a public health insurance system should be established to provide competition to the private health insurers, which have demonstrated an unwillingness to contain costs. The private insurers have no incentive to contain costs, they simply raise rates each year.

Obama and democratic Congressional heavy hitters have indicated their support for the public option, while medical and pharmaceutical industry interests have announced their opposition, as they recognize their privately held entities will not be able to compete with the lower administrative costs and non-profit nature of a public insurance system.

The current health insurance reform discussions bring to mind my days working as an administrator for East Grays Harbor County, WA local governments.

During the early 1980s liability insurance rates were surging, causing WA local governments to look for an alternative. City’s had theretofore been insured by privately owned insurers through policies secured usually through a local broker, after calling for bids.

The private insurers would base decisions as to whether to settle or fight claims based upon purely economic considerations, that is which would be cheaper, without any consideration as to whether the claim was valid. I will not burden you with the details of a particularly disgusting example of a private insurer paying a claim which disparaged the good work of volunteer municipal ambulance personnel because paying was cheaper than fighting the unjust claim.

The private insurers, through their practice of paying nuisance claims rather than fighting, encouraged the filing of claims against local governments by trial attorneys who understood the game. And with a president at the time telling us that “government is the problem”, jurors were predisposed to rule against governments in those cases which went to trial.

Responding to the surging insurance rates, eight Puget Sound area cities joined forces to create the Puget Sound Cities Insurance Authority, since the late 1980s the Washington Cities Insurance Authority (WCIA), through which to pool their risks and buy insurance as a group. Most cities in Grays Harbor County joined the Authority in the mid to late 1980s, Montesano, I think, being the first. Since, the organization has expanded to over 100 WA governmental entity members; and WA counties, as well as local governments around the country, have created similar public insurance authorities.

A representative of each member city serves on the Authority’s board of directors, which not only establishes the organization’s policies but also decides the Authority’s approach to major claims against its member cities.

The Authority’s board, early on, established the principle that it would fight unjust claims against its members, so as to help turn the tide of increasing claims against local governments, which had become favored targets of trial attorneys; and to promptly accept responsibility and settle just claims. Since, the Authority has gained the reputation amongst trial attorneys that it will fight claims on principle, rather than to decide to fight or settle based upon an economic calculations as do privately owned insurers. Consequently claims against WCIA member entities have declined.

Eventually the WCIA board decided to self-insure, a transition which evolved from the initial group purchasing of insurance, to a mix of self-insurance and the purchase of insurance to cover catastrophic loses, to fully self-insured. Eventually, the Authority members self-insured their vehicle exposures, boiler insurance, fidelity bonding, and other such insurance services.

Hundreds of City Councilpersons from throughout WA decided to save the taxpayers of their respective cities lots of money by establishing and joining a publicly owned insurance authority, which has contained costs by taking a principled, rather than simply an economic, stand and through aggressive training and risk management programs to which members must adhere.

There is no reason why the same benefits shouldn’t accrue from a publicly owned, not -for-profit health insurance system.

Please send a message to your congresspersons and senators telling them you support a publicly owned, not for profit, single payer health insurance system; and demanding that, at a minimum, a public insurance option be provided to all USA residents so that consumers have a choice.

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The Blue Dog Coalition’s Approach To Health Care Reform

Friday, June 5th, 2009

The Blue Dog Coalition, composed of 51 democratic congresspersons, at its web site, describes the organization as such.

The fiscally conservative Democratic Blue Dog Coalition was formed in 1995 with the goal of representing the center of the House of Representatives and appealing to the mainstream values of the American public. The Blue Dogs are dedicated to a core set of beliefs that transcend partisan politics, including a deep commitment to the financial stability and national security of the United States. Currently there are 51 members of the Blue Dog Coalition.

But, really the Blue Dogs haven’t heard that the DLC approach, of casting one’s political persona as “moderate”, whatever that means, has passed from fashion. The Obama campaign pretty much drove a stake through the heart of the DLC, not that the approach has ever been all that effective.

The Blue Dogs have released a policy paper, “Health Care Reform: Ensuring Choice in the Marketplace” enumerating the policies its members believe should guide health care reform. Essentially the Blue Dogs are calling for the status quo, and the continuation of a for profit health care system in the USA, indicating that the least expensive health insurance system, a publicly owned, government administered risk sharing pool (health insurance) should be “Available Only as a Fallback“.

The final bullet point of the Blue Dogs two page policy parer.

Available Only as a Fallback: The availability of a public option would occur only as a fallback Fundamental insurance market reforms and increased choice through the Exchange should improve access and contribute to lower costs. However, should the private plans fail to meet specific availability and cost targets, a public option would be triggered and be allowed to compete on a level playing field subject to the conditions outlined above.

Only as a “fallback and in the absence of adequate competition and cost containment.” [emphasis added]

WTF?

Just how much evidence of an “absence of adequate competition and cost containment” do the Blue Dogs need?

The only time I remember when the health care, insurance, and pharmaceutical industries acted to contain costs was when Hillary Clinton scared the crap out of them in the early years of the Clinton administration. The rate of increase in health care costs slowed following Clinton’s unsuccessful effort, as the industries embraced HMOs.

Private insurers have no incentive to contain costs, they simply raise rates. Meanwhile Medicare has contained costs. Having worked for local governments operating money losing ambulance services, I can assure you that Medicare contains costs to a far higher degree than do private insurers.

The following chart, I put together from OEC and WHO data, indicates that we of the USA spend 20% more per capita for health care than does Luxembourg, the second highest spender, and almost 60% more than the average of the thirty countries included.

	Per Capita Health	Life	Child Moratility
	Care Spending	Expectancy	Per 1000 Births
	OECD 2004	WHO 2004	WHO 2004
United States	$6,102.00	78	8
Luxembourg	$5,090.00	79	6
Switzerland	$4,077.00	81	5
Norway	$3,966.00	80	4
Iceland	$3,331.00	81	3
Canada	$3,165.00	80	6
France	$3,158.00	80	5
Austria	$3,123.00	79	5
Australia	$3,121.00	81	5
Germany	$3,043.00	79	5
Netherlands	$3,038.00	79	5
Belgium	$3,023.00	78	5
Sweden	$2,825.00	81	4
Denmark	$2,656.00	78	5
Ireland	$2,596.00	78	4
AVERAGE	$2,552.00	78	7
United Kingdom	$2,508.00	79	6
Italy	$2,467.00	81	5
Japan	$2,249.00	82	4
Finland	$2,235.00	79	4
Greece	$2,162.00	79	5
Spain	$2,094.00	80	5
New Zealand	$2,083.00	80	6
Portugal	$1,823.00	78	5
Czech Republic	$1,362.00	76	5
Hungary	$1,281.00	73	8
Korea	$1,149.00
Poland	$805.00	75	8
Slovak Republic	$778.00	74	8
Mexico	$662.00	74	28
Turkey	$580.00	71	32

And what benefits accrue from that higher spending? Shouldn’t higher spending result in better health care outcomes? Shouldn’t we be living longer and have a lower incidence of child mortality? One may logically think so.

The USA is tied for fifth in life expectancy amongst residents of the thirty countries included in the chart, and fifth in fewest incidence of child mortality.

The fact is that we of the USA pay more for health care to pay profits to health and pharmaceutical industry shareholders; advertising costs; and, to a lesser degree, executive salaries and bonuses.

Where did the Blue Dogs come by the idea that profits must be provided to private interests through our governments efforts to “promote the general welfare”, one of the six purposes of our government as enumerated in the Constitution?

A single payer, publicly owned and administered system of health insurance is the least expensive option to provide health insurance to all. And to those who reflexively pronounce that government administered programs are inherently less efficient than private sector management, take a look a Medicare’s administrative costs compared to the privately owned insurers.

LATER: I should have noted that the 2006 infant mortality rate in Cuba was 5/1000 live births as compared to 7/1000 in the USA. Additionally, life expectancy in Cuba is on par with that in the USA.

Those monstrous Cuban Marxists decided long ago to invest, what they have been able, into health care and education of the Cuban population. The result has been health care outcomes on par with those of far more economically developed nations, the development of world class pharmaceutical and bio-tech industries, and a higher literacy rate than in the USA.

The Chinese, who effected their revolution tens years prior to the victory of the Cuban revolution, on the other hand, have chosen to invest in industrial and military development. China has nuclear missiles, and a 2006 infant mortality rate of 20/1000 live births and a life expectancy of 64.

UPDATE: I just ran across this report, from the Missoulian, that Sen. Kennedy, of Mass., and Sen. Baucus, of MT, are to “to push single health care reform bill“.

HELENA – Montana Sen. Max Baucus, who’s been spearheading health reform discussions in the U.S. Senate, said Monday he and Sen. Ted Kennedy will work toward producing a single, comprehensive bill by August.

The bill, a product of the two key committees chaired respectively by Baucus and Kennedy, will reform the private health insurance market to extend coverage to all, attempt to control rising costs and revise how hospitals and physicians are paid for medical care, Baucus said in a telephone interview.

The package also will include a “strong public option,” which is a government-run insurance plan that would compete with private health insurers, Baucus added.
“I want something substantial accomplished,” he said as Congress prepares to reconvene for the summer. “This is a unique moment in American history to do something different.

And this AP report that “a draft bill circulated Friday by Sen. Edward M. Kennedy’s health committee“contains provisions for “a new public ‘affordable access’ plan that would for the first time offer government-sponsored health care to Americans not eligible for Medicare, Medicaid or other programs“.

WASHINGTON – Employers would be required to offer health care to employees or pay a penalty — and all Americans would be guaranteed health insurance — under a draft bill circulated Friday by Sen. Edward M. Kennedy’s health committee.

The bill would provide subsidies to help poor people pay for care, guarantee patients the right to select any doctor they want and require everyone to purchase insurance, with exceptions for those who can’t afford to.

Insurers would be supposed to offer a basic level of care and would be required to cover all comers, without turning people away because of pre-existing conditions or other reasons. Insurance companies’ profits would be limited, and private companies would have to compete with a new public “affordable access” plan that would for the first time offer government-sponsored health care to Americans not eligible for Medicare, Medicaid or other programs.

A publicly owned, non-profit health insurance risk sharing pool will eventually put the private health care insurers out of business as they would be unable to compete. Good riddance.

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The Most Expensive Health Care System In The World Is Third Rate

Saturday, November 29th, 2008

Ceci Connolly, of the Washington Post reports

“We’re not getting what we pay for,” says Denis Cortese, president and chief executive of the Mayo Clinic. “It’s just that simple.”

“Our health-care system is fraught with waste,” says Gary Kaplan, chairman of Seattle’s cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

——-

The United States today devotes 16 percent of its gross domestic product to medical care, more per capita than any other nation in the world. Yet numerous measures indicate the country lags in overall health: It ranks 29th in infant mortality, 48th in life expectancy and 19th out of 19 industrialized nations in preventable deaths.

——-
One fundamental problem is how doctors are paid, he said. Under the current fee-for-service scheme, “the more you do, the more you make,” Kaplan said. There is no incentive to keep people out of doctors’ offices, hospitals, imaging centers and dialysis clinics.

More tests lead to more procedures, which often result in mistakes, complications, misdiagnoses or the use of untested therapies, said Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Mass. “The current system is very hospital-centric,” he said. “We wait for people to get sick, and then we invest enormous sums to fix them up. We should build primary care as the core.”

Read the whole report, and know that those who extol the USA health care system as “the best in the world” are ignorant or proffering propaganda. Isn’t it amazing to think that a massage might be more effective for treating back pain than is an MRI?

The fact is that private insurers have no incentive to contain costs, through prevention and massages for examples, when all they must do is to raise their rates. The fact also is that Medicare, a publicly owned insurer, has been far more effective at restraining costs and has done so with lower administrative costs.

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Republican Health Insurance Plan – More Social Darwinism

Thursday, August 28th, 2008

A

Dallas Morning News report, widely cited across the blogosphere, includes comments of McCain health care adviser John Goodman, who reports that there are no folks in the USA without health insurance. The report entitled “Texas still leads nation in rate of uninsured residents”, includes this

McCain adviser

But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

“So, there you have it. Voila! Problem solved.”
[I, of course, added the emphasis]

Mr. Goodman’s analysis drew a sharp response from the Center for Public Policy Priorities, an Austin-based think tank focusing on poverty issues. “That is not the same thing as having health insurance,” said Eva Deluna, a budget analyst for the center. People without insurance are less likely to seek care, and when they do, the cost to the health system is greater, she said.

Other republicans, including GDubya, Tommy Thompson, and Tom Delay have made this same argument.

As I know my six readers are aware, treatment in the emergency room is the most expensive manner of providing health care, and the tab is picked up by taxpayers who support public hospitals. Additionally, those who rely on the emergency room for medical services do not receive preventative care, thus when they finally do seek treatment in the emergency room their conditions are often more advanced and, thus, more expensive to treat.

Remember the story of the twelve year old Maryland boy who died from an abscessed tooth, after six weeks in the hospital and treatment, including brain surgery, which cost $250,000.

By the time Deamonte’s own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George’s County boy died.

Deamonte’s death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

Deamonte’s family had Medicaid coverage but was unable to find a dentist who accepts Medicaid covered patients.

So if the constitution of the Supreme Court, and the consequent implications to Roe v Wade, the further expansion of executive power, and the further erosion of civil liberties, is not a good enough reason for folks to not vote for John McCain, his health care plan certainly should be.

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The Best Second Rate Health Care Money Can Buy

Saturday, December 29th, 2007

It is to our national shame that we continue to permit health insurance system drive by the profit motive rather than the “general welfare”, one of the six purposes of our Constitution.

YORKTOWN — Three-year-old Hannah Devane is allergic to food. Not the kind that makes kids spit out their broccoli; the kind that can kill.

The Yorktown preschooler has a condition called eosinophilic esophagitis, a severe food allergy that causes a type of white blood cell to congregate in the esophagus, the tube that carries food from the mouth to the stomach, damaging the tissue when she eats.

A doctor-prescribed formula has allowed Hannah to grow to a robust 40 pounds, a normal weight for a child her age. Without it, Hannah could wind up with a feeding tube.

But the insurance program that covers her family through her father’s job as a New York City police lieutenant has stopped paying for the formula, which costs $1,200 a month. Food supplements and other over-the-counter items are not covered under the family’s insurance, the prescription plan administrator said.

The full report may be found here.

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Profit Driven Health Care Results

Saturday, October 13th, 2007

“For American dentists, times have never been better.

“The same cannot be said for Americans’ teeth.

“With dentists’ fees rising far faster than inflation and more than 100 million people lacking dental insurance, the percentage of Americans with untreated cavities began rising this decade, reversing a half-century trend of improvement in dental health.”

So begins the New York Times report, yet another indication that profit is more important to USA policy makers than is their Constitutional duty to “promote the general welfare.”

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