Quote of the Day
May 12, 2008
UnitedHeathcare's plan with a 10% medical loss ratio
It is astounding that UnitedHealthcare has been able to achieve a medical loss ratio as low as 10%, retaining 90% of the premiums for administration and profit, simply by selling college students nearly worthless products that fail to prevent financial hardship in the face of medical need.
May 09, 2008
Herzlinger and McCanne on "choice" in candidates' proposals
Anyone following the national dialogue on reform is certainly aware of the rhetoric over "choice." Those supporting reform that builds on private health plans use "choice" to mean choice of health plans. Those supporting a publicly financed and publicly administered national health program use "choice" to mean choice of physicians and hospitals and other health care professionals and institutions.
May 08, 2008
AHIP on Medigap's Impact On Medicare Costs
Medigap plans are standardized supplemental private insurance plans that fill in some of the gaps in Medicare coverage. Medigap plans, as a group, have amongst the lowest medical loss ratios of all private insurance plans; that is, they pay out the least for health care benefits. Thus the plans are very lucrative for the private insurers, but they are amongst the worst values in private health care coverage.
May 07, 2008
Millennials support a government health insurance plan
The bad news is that Millennials face "lower rates of healthcare coverage, worsening job prospects, and higher levels of student loan debt." The good news is that they now "reject the conservative viewpoint that government is the problem, and that free markets always produce the best results for society."
May 06, 2008
Who determines whether we have coverage?
These two studies released today add to the great body of policy literature that demonstrates that the decision to have health insurance is often removed from the individual and is under the control of extraneous factors.
May 05, 2008
Health Care for Latinos
Dr. Torres is absolutely correct, except that we don't need to make it a moral issue. It already is.
May 02, 2008
Understanding your own insurance
Although this was a J.D. Power study of consumer satisfaction, it does reveal a very important point. Only 45 percent of health plan members self-reported that they understood their health insurance coverage. The other half didn't, and that was correlated with lower satisfaction ratings.
May 01, 2008
CBO looks at Wyden/Bennett S. 334
Although the bill has provisions that nominally would slow the increase in health care costs, they are similar to the cost-containing provisions of the proposals of the presidential candidates that actually would have very little impact, if any, on slowing cost escalation. It became apparent that adjustments would have to be made in S. 334 to prevent increasing demands on future federal budgets.
AHIP on "Health Savings Account Plans"
So anyone who can read plain English now knows that the are more than six million health savings accounts. But wait a minute. This study shows only that there are more than six million high-deductible health plans (HDHPs) which meet the qualifications to establish a health savings account. They have only partial information on less than 800,000 actual health savings accounts and cannot tell us whether the other five million accounts were even established, much less funded.
April 29, 2008
Sen. McCain's Guaranteed Access Plan
This speech was promoted as a major policy address that would flesh out Sen. McCain's proposal for health care reform, according to his campaign spokesman Jeff Sadosky. Until now, the only real substance of his proposal was to offer a tax credit, $2500 for individuals and $5000 for families, to purchase health plans in a competitive, deregulated private insurance market. Most of the rest of his proposal is simply rhetorical fluff.
April 28, 2008
Is LipiScan a gizmo?
Think of how often a medical technology firm has suggested simple, inexpensive clinical management of a condition that would obviate the need to use their very expensive technology. Never? Yet those supporting market financing of our health care system insist that it encourages technological advances which provide higher quality care at lower costs. What we are receiving instead is much more expensive care, often of dubious value.
April 24, 2008
Marcia Angell on relationship between coverage and costs
By Marcia Angell | The American Prospect
All of these variations in the Democrats' plans run into this intractable dilemma: If the system stays essentially as it is and we try to expand coverage, costs will inevitably rise. On the other hand, attempts to control costs will inevitably reduce coverage.
April 23, 2008
KFF Primer on private coverage
Much of the discussion on reform that will take place in the next couple of years will be on reform of the private insurance market. Of course, that is not the discussion we need to have. We should be discussing how to replace the private insurance market with a single payer national health program.
April 22, 2008
AHIP's lessons learned
Those of us who contend that private insurance is an obsolete method of financing health care are not the least surprised by AHIP's statement that "many companies accepted applications for insurance that they should have refused as bad risks." AHIP's contemporary position is that private insurers should not cover individuals with significant health care needs because that drives premiums so high that they are priced out of the market. Instead they support taxpayer-funded programs to pay for the 80 percent of health care used by the 20 percent of people who have higher health care needs.
April 18, 2008
The political rhetoric of "socialized medicine"
For political reasons efforts often are made to obfuscate the definition of "socialized medicine," but it is important to understand the meaning of the term. A socialized medicine system is one in which the government is the owner of the health care delivery system, and professionals providing the health care are employees of the government.
April 17, 2008
ANA position on single payer
It is gratifying to see that the American Nurses Association ultimately supports a single payer mechanism.
April 16, 2008
"Sick Around the World"
Washington Post reporter T. R. Reid takes a look at the health care systems of the United Kingdom, Japan, Germany, Taiwan, and Switzerland, and shows how each has settled on different models that are simpler, fairer, cheaper, and include everyone. He contrasts these nations with the United States which is "unlike every other country because it maintains so many separate systems for separate classes of people."
April 15, 2008
ACS testimony on underinsurance
To keep premiums affordable, the private insurance industry has no choice other than to pass more of the costs of health care on to individuals who have greater health care needs - thus the epidemic of underinsurance.
April 14, 2008
Tax evasion through HSAs
HSAs are a tax scheme in which we taxpayers subsidize the health care of individuals with incomes high enough to qualify for the tax relief. It would be inappropriate if these taxpayer-subsidized funds were used to purchase entertainment centers or expensive vacation trips. Unfortunately, the only way to ensure that these funds are used for health care is to establish an administrative process to clear each payment made out of the accounts. Otherwise, the temptation for individuals with HSAs to cheat their fellow taxpayers is just too great. It is far better to remove the temptation in advance than to penalize it after the fact.
April 11, 2008
WellPoint and UCLA privacy breaches
Although EMRs and IT systems are helpful tools, they introduce exposure to privacy breaches that have implications far beyond those of paper records. Looking through a patient's paper chart is one thing, but obtaining digital information that can be unleashed over the Internet for all the world to see, without any possibility of retracting the release of that information, is quite another.
April 10, 2008
AHIP's definition of equity
So the private insurance industry, in order to establish equity, would set their premiums based on health care costs of $1970 each (plus administrative costs and profits, less cost-sharing) for four-fifths of us. But what about the one-fifth with health care costs averaging $31,400 each? They simply avoid that market.
April 09, 2008
Health reform lessons from Chile
This article is worth reading in its entirety because of the important lessons that would apply to reform in the United States.
April 08, 2008
Medicare's failed experiment with disease management
The presidential candidates claim that they will pay for expanding coverage to everyone by using the savings made possible though chronic disease management. But what is disease management, and will it save money?
April 07, 2008
2008 Dartmouth Atlas of Health Care
Just imagine how effective a single payer national health program would be in "transforming the management of chronic illness to a rational system where what happens to patients is based primarily on illness severity, medical evidence, and the patient's wishes, and where resource allocation can be guided more and more by knowledge of what is needed to produce cost-effective, high-quality care."
April 04, 2008
Health insurance in small firms
This report provides extensive data documenting the increased burden of employer-sponsored health insurance, especially in small firms. Those interested in defining and quantifying the extent of this problem would be interested in downloading this report.
April 03, 2008
WellPoint tanks
WellPoint has been the leader in marketing innovative "affordable-but-barebones plans that do not offer consumers a compelling value." So now the industry will need to reverse its downturn by creating "affordable health insurance plans that consumers really want to buy."
April 02, 2008
OECD paper on the economics of prevention
This paper is important to policy advocates since it will arm you with the confidence to reply to questions about and proposals for prevention. It is also a paper that you can recommend to individuals who are locked into the concept that health care reform is all about prevention. You can show that that prevention is crucial, but that it alone does not adequately address the very important issue of making access to the health care delivery system affordable for everyone.
April 01, 2008
Twice as many physicians support National Health Insurance as oppose it
The debate over physician support of national health insurance is over. A majority of physicians are clearly in support, and that support continues to grow.
March 31, 2008
The insurance industry elephant
Wake up America! There's an insurance industry elephant in the room!
March 28, 2008
Hillary Clinton on single payer
Is she suggesting that the private insurance industry will be able to provide us with an insurance product that includes all of the bells and whistles at a premium that is affordable? If such a plan were to be offered it would have a very small market limited to only the wealthiest of us. Insurers typically shun small markets.
March 27, 2008
Hospitals requesting payments upfront
The hospitals are not the villains here. By introducing high-deductible plans, the private insurers have relieved themselves of the responsibility of paying for the initial costs of the medical and surgical procedures and services. In so doing, they have placed the burden of obtaining payment of the upfront charges onto the hospitals and health care professionals. Since large medical bills are more difficult to collect after the services have been provided, it is only natural that the hospitals would request payment in advance.
March 26, 2008
AFL-CIO/Peter Hart health care survey
This twenty-eight page reports provides statistical data in tables and graphs that demonstrate the level of dissatisfaction with our health care system. Two of the more revealing numbers are that "ninety-five percent say they are somewhat or very concerned about being able to afford health insurance in the coming years," and "ninety-five percent of respondents say America's health care system needs fundamental change or to be completely rebuilt."
March 25, 2008
Federal outsourcing increases uninsured
We won't get it right until we're ready to automatically enroll absolutely everyone in a single national health program. Until then, even the government will game the system.
March 24, 2008
More on wages and health care costs
This report is further confirmation that increases in health care costs are not being absorbed by employers but are being passed on to employees in the form of forgone wage or salary increases.
March 10, 2008
Do health benefits reduce wages?
Everyone agrees that health benefits provided by the employer are part of the employee compensation package. And there is considerable evidence that employees do accept lower wages in order to be able to participate in the employer's health benefits program.
Yet when employees are left on their own to secure their health insurance, they do not purchase it.
March 07, 2008
Consider signing PNHP's letter to the candidates
If you would like to join us in sending this message to the presidential candidates then use the link above to add your name to the list of those endorsing this letter. Your name and city will be posted as a signer to the letter.
February 29, 2008
Minnesota physicians prefer single payer
When you hear that the AMA is opposed to single payer reform, keep in mind that it represents only a minority of American physicians, and within their organization there is a diversity of opinion.
February 28, 2008
AHIP's recommendation for rescissions
Our goal is to bring everyone under the health care financing umbrella, including those with significant health care needs. The goal of the insurance industry is to bring the healthy under their umbrella, while excluding those with health care needs.
Focusing on coverage, or costs?
Ezekiel Emanuel is certainly correct when he states that we must focus on health care costs as we expand health care to everyone. He is also correct when he implies that current political proposals such as electronic medical records, wellness programs, quality incentives, and disease management programs would not have any significant impact on controlling spending. But he is wrong when he implies that there is no reform proposal that would both control costs and cover everyone.
February 26, 2008
Health care spending for 2008
The projected numbers for 2008 are the most reliable estimates of our current health care spending. They are the numbers you should use in your advocacy work.
February 22, 2008
Making Medicaid patients better shoppers
So under the new rules, a family of four living at the federal poverty level ($21,200) can be granted "greater control over their health care decisions" by being granted the opportunity to use $1060 of their own income in order to make them better health care shoppers.
February 21, 2008
The Corrosion of Medicine
Although physicians have been complicit in the processes leading to the corrosion of medicine, their blame lies not with an active role in commercializing health care, but rather with passive acceptance of their role in our current model of health care that is controlled by business and market interests.
February 20, 2008
Will targeted policies work for the uninsured?
The fact that the number of uninsured continues to increase is certainly not news. But there are a couple of points in this article that should alarm us.
A rebounding economy was unable to stop the decline in coverage. In spite of favorable economic trends, employers found their health benefit programs to be less affordable, and more dropped their employees from coverage. Clearly we will not be able to rely on improvements in the economy alone to expand coverage to more individuals.
February 19, 2008
Lewin Group analysis of "Health Care for America"
Rather than crafting health care financing based on individual plans, whether public or private, it would be far more efficient and equitable to totally separate health care financing from the delivery of health care services. Establish a single, universal risk pool, funded equitably through the tax system, and then use that common pool to fund health care.
February 14, 2008
Insurers' IT innovations shift costs to patients
Most current proposals for reform call for an expansion of IT (information technology) services to help control health care costs. Ingenix is demonstrating just how the private insurance industry adapts IT innovations to our health care system. It is using IT to shift more costs to patients while "increasing the profitability of a typical health plan by up to 16.7 percent."
February 13, 2008
Grumbach and GAO on primary care crisis
The current dialogue on reform is often more narrowly focused on topics such as disease management and electronic medical records. More attention needs to be directed to reform that would put all of this together: reinforcing our primary care infrastructure.
February 12, 2008
Blue Cross asks doctors to rat on patients
As we have seen before, Blue Cross's very successful business model is often in conflict with the mission of physicians and other professionals to provide the health care that patients need. This letter to physicians has a particularly nefarious intent.
February 11, 2008
End fringe debate over mandates - Kuttner
Talk about incompetent framing of the health care reform debate. Clinton and Obama are engaged in a cat fight over coercing the purchase of unaffordable and inadequate private plans, versus allowing individuals to go without coverage because it is unaffordable. Neither is acceptable.
February 08, 2008
Get ready for a Blue Cross/Blue Shield retailer near you
Placing the consumer in charge of his or her own health care has been touted by the supporters of consumer-directed health care as the answer to our health care cost crisis. This includes providing consumers with a choice of coverage options in the individual private insurance market.
February 07, 2008
Kuttner on market-based failure
How many articles have you seen or speeches that you've heard begin with the premise that we must first eliminate the waste in our health care system before we can provide health care coverage for everyone?
February 06, 2008
Is "keeping the insurance you have" your choice?
Quick! How many of you, under age 85, have the same health insurance plan that you had twenty years ago? None?
OK. Then how many of you changed plans simply because the private insurance market offered new plans with improved benefits and lower premiums? None?
February 05, 2008
More administrative fraud
Accepting accounts receivable as security for short term loans is a process know as factoring. Based on this report, it appears that National Century was yet another administrative intermediary that used a variation of factoring to divert 10 to 20 percent of health care dollars to its own interests. As if we didn't have enough administrative excesses in our system already, this is an atrocious waste of resources.
February 04, 2008
Krugman on Gruber on individual mandates
Jonathan Gruber and Paul Krugman deserve their reputations as being amongst the most respected economists in the nation. But their fixation on individual mandates provides about the same level of insight as to what we need in the way of health financing reform as does the insight provided by the proctologist who tries to tell us our general state of health from his perspective.
February 01, 2008
Oregon's health care lottery
Oregon has long been admired for its innovative efforts to expand coverage in an environment of limited state resources. It has even seriously considered single payer reform.
But a lottery to provide coverage for 10,000 to 12,000 of Oregon's 600,000 uninsured adults? Come on!
January 31, 2008
Eliminating broker fraud
In a single payer national health program enrollment is automatic and permanent. Churning, twisting, misrepresentations of coverage, and falsified applications wouldn't even exist.
January 30, 2008
Contingent workers and health care
"Only 13% of contingent workers had health insurance provided by their employer, compared with 72% of noncontingent workers."
It is unrealistic to expect employers to provide long-term health benefits to these employees who move in and out of their workforce. Because of changes in income, residency, dependent status, and so forth, it is also very difficult to provide stable enrollment in public insurance programs.
January 29, 2008
California reform defeat and UnitedHealth
There is no celebration in California. We are back to the status quo. Although those who call for compromising fundamental health policy principles say that the status quo is everyone's second choice, it isn't. It's our last choice.
January 28, 2008
Caps on catastrophic losses
Those of us who support single payer national health insurance believe that access to health care should not be impaired by erecting financial barriers to care. Others believe that individuals should be responsible for "modest" costs that enable access to care, such as high-deductible plans (conceding that low-income individuals would need some assistance). But everyone agrees that we should all be protected from catastrophic health care expenses. So why do private health plans place a cap on catastrophic losses, forcing financial ruin on those with the greatest of catastrophic health circumstances?
January 25, 2008
IOM report: Knowing What Works
Our mishmash that we call a health care system has two general characteristics that must be rectified. First, we provide both insufficient and excessive health care services that fall far short of the goals of high quality health care and optimal health care outcomes. Second, we waste an enormous amount of funds on poor quality, ineffective care while failing to spend enough on efficient, high quality services.
January 24, 2008
The fantasy numbers of the Schwarzenegger/Nunez proposal
Although this analysis was done for the compromise reform legislation currently under consideration in California (ABX1 1), the general principles apply to all comprehensive proposals that would mandate individuals to purchase private insurance plans.
January 23, 2008
Initiating a market for organs
Vendors? Of their own organs?
Those who support treating health care as a commodity surely didn't imply that we should go to this extreme. Or did they?
January 22, 2008
Prior authorization without payment authorization
UnitedHealthcare's "Advance Notification" protocol is very similar to established preauthorization protocols in that the insurer can deny payment if the process is not followed prior to the provision of health care services. The physician must submit the same information, in advance, that is required for preauthorization. The important difference is that fulfilling this identical notification requirement no longer ensures that the physician will be paid.
January 18, 2008
Americans lack understanding of their private health plans
Although this survey was designed to be used in the promotion of eHealthInsurance, an online health insurance broker, it does provide information that is useful to health care reform advocates.
January 17, 2008
Understanding insurer profits
Although the diversion of health care profits to the private insurers makes us angry, we have to keep in mind what the greater problem is. The private insurers are a major component of our highly flawed, fragmented, multi-payer system of financing health care. Between the administrative excesses of the insurers and the administrative burden placed on the providers of health care, we waste about $350 billion that could be recovered by changing to an administratively efficient single payer system. We do want to recover that $12 billion from the core underwriting business, but it is far more important to recover the $350 billion through structural reform of our system of health care financing.
January 16, 2008
Rex Nutting on health care reform
Supporters of national health insurance certainly can identify with these comments. But why are they worth sending out as a Quote of the Day? It's the source of the comments. Rex Nutting is Washington bureau chief of MarketWatch, a subsidiary of Dow Jones and Company.
January 15, 2008
Commonwealth Fund on candidates' reform proposals
The policy principles listed above are key to moving us toward a high-performance health system - except one. Avoiding "dislocation" by allowing an individual to elect to continue with a private plan that limits choice of providers, limits benefits, and requires greater cost sharing does not move us closer to a high-performance system but is included for pure political reasons to appease those individuals who remain uncomfortable with the concept of a public insurance program that they don't fully understand. All of the other principles listed should be an integral part of comprehensive reform.
January 14, 2008
Employers spend more to insure fewer
Under our current system of financing health care, it certainly seems only fair that an employer who is generous enough to offer dependent coverage (even if nudged by union negotiators) should not be expected to cover additional relatives or friends of employees if those individuals are not eligible dependents.
January 11, 2008
High burden hits middle-income America
The policy lesson? One-fifth of privately insured, middle-income people are already classified as "high-burden individuals" because they live in families that spend more than ten percent of their family income on health care, "and this number is likely to increase in future years as health care costs continue to outpace growth in family incomes."
January 10, 2008
Make that 22,000 uninsured deaths
More numbers...
Is this what the health care reform movement is all about?
Do we just keep tallying casualties? Body counts that aren't real body counts? Policy studies from statistical tables that are devoid of any references to real human beings that we knew and loved?
January 09, 2008
United States has worst rate of amenable mortality
Amenable mortality is defined in this study as "deaths from certain causes that should not occur in the presence of timely and effective health care."
January 08, 2008
Health spending growth slower than what?
Increases in health care spending continue to outpace increases in wages, and it is only going to get much worse. Paul Ginsburg tells us why. The players in the health care delivery system are busy chasing the buck with ever more excessive high-tech services and facilities, while only cursory attention is being given to actual health care needs (or sometimes no attention, as in mental health).
January 07, 2008
Missing the Boat on Health Care?
John Geyman's Tikkun article on whether we are about to miss the boat on health care reform is an important piece that you may want to share with others. The policies that we need to enact are clear, but they are taking a back seat to politics, being an election year.
January 04, 2008
Market justice and moral compass
The quasi-electromagnetic fields of market justice have screwed up our moral compass. Let's take it over to the terrain of social justice and see if we can get it to work again.
January 03, 2008
Denying care or denying payment?
Blue Cross has been a leader in insurance plan innovations that slow the rate of premium increases (to a smaller multiple of the rate of inflation) in order to remain competitive in the health insurance market. Blue Cross suggests that they are balancing "assuring access" with "keeping costs as affordable as possible for all of our members." But their scales are locked in at (barely) affordable premiums, which requires that they increase financial barriers to access. Changing the copayment for Pulmozyme from $30 to $784 is a good example. They continue to have "access" since Pulmozyme is still covered in another drug tier, and they continue to have "affordable" insurance premiums.
January 02, 2008
Where are we on reform? Part 2 (Hacker)
The final Quote of the Day for 2007 discussed the disconnect between a new poll indicating strong support (65%) for "a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers," and a rapidly growing movement within the progressive community to support a model based on allowing you to keep the insurance you have.
December 31, 2007
Where are we on reform?
From a policy perspective, the nation now believes that "the United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers." The majority also supports the concept framed as "single payer," though the Medicare framing elicits stronger support.
December 21, 2007
The insured should be very, very afraid
For health reform advocates, this report is well worth downloading. It confirms not only the enormity of the financial burdens of health care, but also the alarming rate of increase in those burdens.
December 20, 2007
Insurance and cancer
There are many factors that influence access and outcomes for cancer patients. This comprehensive study confirms that insurance status is one of the most important factors. The uninsured are screened less frequently; they are diagnosed at a later stage, and they have a lower survival rate.
December 19, 2007
AHIP's Guarantee Access Plans
AHIP is proposing that they be relieved of covering any individual that the actuaries predict might cost twice the average of claims in this very low cost group. Everyone who might actually need care is transferred to the Guarantee Access Plans managed by the state. These plans would be funded by a premium with a 50 percent penalty added, plus financing that the state obtains from "a broad base of sources." That broad base, of course, is the taxpayers.
December 18, 2007
Scrap the California victory celebration
The millions who do not qualify for the medical welfare programs, and don't have enough income to pay the premium for the "minimum creditable coverage" are excused from being included in our universal health care program.
December 17, 2007
Yet another administrative siphon
What we do not need is more administrators that find innovative ways to move health dollars around while taking their percentage of every dollar they touch. HMS wouldn't even exist if we had a single payer national health program.
December 15, 2007
Mandate model repeatedly tested in U.S. and always fails
Again, proven repeatedly, the “mandate model” for reform is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.
December 14, 2007
David Himmelstein speaks
Harvard professor and PNHP cofounder David Himmelstein presented his remarks following a roundtable discussion by the health policy representatives of the leading Republican and Democratic candidates for president.
December 13, 2007
The new Dutch health insurance system
The recently adopted financing reform for health care in the Netherlands has received considerable attention in the United States, and is being proposed as a private sector model that would be especially compatible with American ideals. The Dutch have discontinued their public insurance program and replaced it with an individual mandate to purchase private health plans competing in the marketplace.
December 12, 2007
Watch your medFICO score!
You can get an idea of the magnitude of the growth in the market of inadequate underinsurance products when the industry has identified yet another administrative service that they can sell us: a medical FICO score to determine the creditworthiness of patients who have significant out-of-pocket expenses as a result of today's higher cost-sharing requirements.
December 11, 2007
Australia learns wrong lesson from U.S.
It is often said that private insurers in other nations with less expensive, universal health care systems are very different from those in the United States. They are highly regulated, non-profit entities that serve patients well. But is that always true? Step back and take a look at what is happening in Australia.
December 10, 2007
Better morale with no insurance?
You know that we have serious problems with our health care financing system when a policy expert states that it is better for morale if new small business owners never offer their employees health insurance in the first place.
December 07, 2007
Anthem's bare-bones plan for employers
Although the numbers of uninsured continue to rise, the fastest growing problem in health care financing is underinsurance. In an effort to make health insurance premiums affordable, plans are shifting more of the costs to patients, making health care access unaffordable for many.
December 06, 2007
Maine's policy lesson to the U.S. - update
Today's lesson: Most of the nation's leading politicians who claim that their proposals will achieve health care coverage for everyone are being dishonest with us. Worse, their positions are being supported by highly respected, presumably credible members of the policy community. Politics is displacing policy science in the national discourse on reform.
December 05, 2007
Reform that women need
Health care reform is very much a women's issue, though a high-performance health care system that works for women works for men and children as well. If we do it right, we'll all benefit.
December 04, 2007
ACP's position on single payer reform
The American College of Physicians agrees that there are really only two options, though they are both government solutions: (1) an efficient, single payer national health program, or (2) a more expensive, administratively complex, inefficient, highly regulated and heavily subsidized fragmented system of a multitude of private plans plus public programs, with means testing and mandates to participate. It doesn't seem like a difficult choice.
December 03, 2007
Pervasiveness of California rescissions
Although California has been in the news because of the rescission practices of its private insurers, this article demonstrates the pervasiveness of this practice.
November 30, 2007
Woolhandler and Himmelstein on competition and public funds
Although this article is targeted to policymakers in other countries who currently are experimenting with American-style privatization, it actually is a good resource article for health care reformers in the United States. It is worth downloading in its entirety.
November 29, 2007
Genentech bumps $40 drug with $2000 version
The pricing of drugs is not based simply on their development and production costs but rather is based more on what the market will bear. The ability of compounding pharmacists to greatly dilute the dose of Avastin to levels appropriate for treatment of the retina resulted in a plummeting of the price per dose compared to that of Lucentis.
As any successful business would do, Genentech made a decision to destroy its own competition with itself by prohibiting the legal sale of Avastin to the compounding pharmacists.
November 28, 2007
Medicare out-of-pocket spending
Most of us are grateful that our seniors have Medicare coverage so that they don't have to face financial hardship in the event of medical need. But is that assumption valid?
About 40 percent of Medicare beneficiaries spend more than 20 percent of their incomes on health care. For most of them that does constitute a financial hardship that is severe enough such that some will decline beneficial health care services simply because they can't afford to pay for them.
November 27, 2007
Access barriers for low-income families
This is yet another study of coverage, access and costs for low-income families. The findings are intuitive, not to mention having been supported by many other studies.
November 26, 2007
Insurance payment confusion leads to bad credit reports
So you have excellent coverage. About six months ago you received medical care for what proved to be a minor problem. The care included a couple of office visits, a few laboratory tests, medical imaging, two prescriptions, and you're fine now.
November 23, 2007
Democratic candidates question reform proposals
There seems to be a consensus that the Democratic presidential candidates are leading on the issue of health care reform. But what are they leading with?
November 20, 2007
Candidates propose opportunities for private insurers
All proposals of the leading Republican and Democratic candidates for president would use various tax policies to increase funds available for the purchase of private health plans, especially in the individual market. Does this really provide greater opportunities for private insurers to expand their markets and increase their revenues?
November 19, 2007
Employers are shifting more costs to employees
The continued escalation of employers' health benefit costs at twice the rate of inflation is bad news, but what is much worse is that employers have responded by shifting even more of the costs to their employees. These increases compound each year.
November 16, 2007
Roadblocks in the private insurance maze
Although this article provides considerable detail, no attempt has been made here to extract from it some of the numerous barriers faced by Barbara Calder - barriers deliberately erected in our system of private insurance plans. Suffice it to say that our fragmented system resulted in "a year battling numerous roadblocks," and her battle isn't through.
November 15, 2007
Renew it or lose it
One crucial feature of a health care program that covers everyone is that enrollment must be automatic and permanent. Obviously we fall far short of that now, but disenrolling an employee because of passive inaction is certainly a further step backwards.
November 14, 2007
The AMA and single payer policies
The AMA calls for coverage to be universal, continuous and portable. Those goals would be automatic with a single payer system, but they would be almost impossible to achieve with a fragmented market of private plans that change their benefits frequently and enter and leave various markets at their own discretion. The only person who can say that he or she has the same continuous, portable plan for the past forty years is a 105 year old Medicare beneficiary.
November 13, 2007
Is reform to benefit underwriters, or patients?
A very recent Quote of the Day message included the comments of Janet Trautwein who represents the National Association of Health Underwriters. She stated that we need to consider "free-market reform, and just say no to single payer." It was followed by my criticism of underwriters whose role is to deny coverage of individuals with health care needs in order to protect insurers from the costs of that care.
November 12, 2007
Does universal health care suppress innovation?
You should immediately download the entire article and save it for a time that you can read it in its entirety. More importantly, the full article should be used in your advocacy work to explain why innovation would not be suppressed - and actually may be made more efficient - by enactment of a universal health care program.
November 09, 2007
Underwriting is part of the problem
The Quote of the Day for October 31, 2007 was from a Modern Healthcare article, "Universal healthcare crosses the partisan divide," which mentioned that many attendees at the meeting of the Health Industry Group Purchasing Association seemed to believe that, "Like it or not, within the next few years the U.S. is going to have a nationwide, single-payer system." Following is a response to that article, and two responses to the response.
November 08, 2007
Highmark's Healthcare Gift Card
Any innovation that the health insurance industry can devise to drum up more administrative fees, they'll do. In this instance, Highmark wants not only more fees, but they also want other insurers' administrative fees as well, claiming its patent rights to the intellectual capital.
November 07, 2007
Oregon rejects health care for children?
This measure couldn't fail. Everyone supports health care for children, and almost everyone supports tobacco taxes that would give smokers a greater incentive to quit. Only the evildoers in the tobacco industry would be opposed.
Well, people in Oregon watch TV, and the vested interests with a lot of money control the message. The tobacco companies were able to frame this as an issue over taxes and government accountability. Who believes that we need more taxes? Who supports the ubiquitous inefficiencies of government bureaucracies?
November 06, 2007
Why would Big Business defend ERISA?
With the escalating push toward comprehensive reform, Big Business has an opportunity to dump its health benefits headache onto others through individual mandates to purchase private plans, or onto a national health insurance program. Why should they want to protect ERISA and their self-funded health benefit programs?
November 05, 2007
Expensive mediocrity
Nothing new. This is yet another international study of health care experiences demonstrating that the United States has the most expensive and least efficient system and that we have the most negative views of all the nations studied. We have a lousy system, and we don't like it.
October 31, 2007
Conservative businessmen sound out single payer
What is remarkable about this report is how far the debate on reform has come. This was a meeting of conservative businessmen in the health industry. The debate is no longer over whether we need comprehensive reform; that is now a given. The debate has progressed to considering the financing mechanism, or, as Pat Buchanan said, "How are we going to pay for it?"
October 30, 2007
Zycher's dishonest report on administrative costs
Normally we wouldn't respond to a dishonest study like this since it would give it further unwarranted exposure and provide it with a limited degree of credibility merely because we thought it was worth our time to comment on it. Unfortunately, The Wall Street Journal has granted it their editorial stamp-of-approval, and the conservative and libertarian non-think tanks are gearing up to be certain that the conclusions in Zycher's report are widely distributed. We will be hearing more about this, and we should be prepared to respond.
Primary care turnover in private plans
One of the most important goals of health care reform is to provide everyone with access to a primary care medical home. Not only would that enhance the quality and cost effectiveness of health care, but it would also provide each person with a long term relationship with a trusted health care professional.
October 26, 2007
AHIP's deceptive release on CDHC
Wait a minute. That's what the press release would have you believe. But what did this study really show?
Individuals with their own health savings accounts (HSA) spent $6 less than those with traditional plan without a deductible (2.8% less). That's not very impressive.
October 25, 2007
Oberlander on learning from failure
It would be a shame to see so much more suffering occur before we could achieve reform. What would the healthy want to hear now, before their personal finances are threatened by medical costs, that would make them want to change to a public program ?
October 24, 2007
Rewarding physicians for providing less care
By using "mountains of billing information," the "best dollar value" will be determined by the frequency and intensity of services. Physicians who see their patients less frequently, do fewer procedures, and provide fewer intensive visits will be paid more for the services that they do deliver. The physicians who are most successful at selecting a larger number of healthy patients and dumping the sick ones will receive the highest compensation.
October 23, 2007
Schwarzenegger and Clinton plans similar
Gov. Schwarzenegger and Sen. Clinton insist that the solution is to require individuals to purchase private plans that they cannot afford. That might work for the wealthy, and for the poor on welfare programs, but that does not work for the majority of us who are just trying to make ends meet.
October 22, 2007
Same health care program that covers Congress
So to make federal coverage more affordable we would convert it into catastrophic coverage that still wouldn't be affordable for most average-income individuals, and would expose many of those who are covered to financial hardship? And to do that we would sacrifice efficiency, equity, and the ability to effect positive changes in public health?
George Lakoff: Don't Think of a Sick Child
Professor Lakoff and his colleagues at the Rockridge Institute now provide us with important guidance for understanding and framing the health care debate.
October 18, 2007
Affordability threshold for family health care
A median family income is no longer enough to pay for premiums plus out-of-pocket expenses for a family facing chronic conditions or facing a significant injury or major illness. Furthermore, there is no standard income level above which individuals could be assured that health care would be affordable.
October 17, 2007
One minute with Al Gore
Al Gore: "I strongly support universal, single payer, government-provided or government-funded health care."
October 16, 2007
Nobel Prize in economics, and why
The next time someone insists that we must keep the government out of health care and allow the free market to work, stop him or her right there. Insist that he/she first read the Milbank Quarterly article by Joseph White so that you can have an informed discussion based on knowledge and understanding of the realities and complexities of marketplace and government interactions and the impact that they have on health care.
October 15, 2007
Letter to Gov. Schwarzenegger
Following is a letter that I sent to the governor last month making the point that affordable, comprehensive health care for everyone is attainable if we truly accept his call for a post-partisan solution with shared responsibility. Although the negotiations are not public, there is no evidence that the policy discussions have extended beyond the obsolete model of private health plan financing. This letter is being distributed in hopes that others will join in the call for reform that will achieve our goal of comprehensive health care for everyone. Please share this message with others who do care.
October 09, 2007
"No Worry" health plan
No worry. Employers can now lock in their premium rates by merely agreeing in advance to pass on health care cost increases to their employees through yet higher deductibles and co-payments.
Private plans fail Medicare audits
So Democrats "are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients." So why do the leading Democratic candidates insist that private insurers be included in their models of health care reform for the rest of us?
David Lazarus gets personal
David Lazarus now not only reports it; he lives it.
October 03, 2007
Being drugged into prevention
Uh-oh. Are we being dragged (drugged) into a process that places our health care system in the hands of the pharmaceutical industry?
October 02, 2007
High chronic disease prevalence and high spending
Are we spending so much more on health care than the other OECD nations because we have a much higher prevalence of chronic disease in older individuals, or are we spending much more merely because our prices are higher?
October 01, 2007
Stories from the marketplace
What do these stories have in common? They are examples of the marketplace at work, and it is our health care system and those it serves that are the victims.
September 28, 2007
Privatized "Big Brother"
Big Brother is watching you. Only he is not from the government. He is an agent of the Invisible Hand.
Intrusive micromanagement of health care today is not coming from an oppressive government, but rather it is an innovation of the free marketplace.
September 27, 2007
Employers offer private underinsurance
Although the numbers of uninsured continue to increase, the fastest growing problem in health care financing today is the transformation from insurance to underinsurance.
Private insurers have shifted much of the individual market into various innovative underinsurance products. Until recently, employers have attempted to maintain more comprehensive coverage. That has changed.
September 26, 2007
Cost savings through prevention and wellness
Prevention and wellness programs are certainly to be encouraged for their beneficial impact on health. They should be an integral part of our health care delivery system. Much more importantly, they should be incorporated into all other appropriate public and private endeavors.
September 25, 2007
Inexorably rising costs
Providing health care coverage for everyone and making health care affordable are two different issues, though they are both problems that are inversely related to income.
September 24, 2007
Cracks in the moral hazard foundation
This landmark report turns upside down the policy basis of moral hazard. The entire article should be downloaded so that it can be used to refute those who insist that patients who decline health care when they have to pay for it out-of-pocket will not adversely affect their own health because they will decline only that care that has no measurable benefit on their health outcomes.
September 17, 2007
Hillary Clinton's "American Health Choices Plan"
Hillary Clinton's proposal "preserves existing health insurance," and includes the responsibility of individuals "to get and keep insurance" through the current private insurance market, or through a "Health Choices Menu" of private FEHBP-type plans, or through a Medicare-type public program.
Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.
September 14, 2007
Is it the prices?
So we pay far more for health care, but we are not receiving any more care than is delivered in other nations. In fact, this article states, "the availability of health care resources and the actual use of services in the United States were below those of most industrialized countries."
September 13, 2007
Decline in premium increases is still an intolerable increase
This year's premium will be used as the basis for next year's increase. This year it is 3.5 percentage points more than the rate of inflation. That greater-than-inflation increase will never be recovered, and will be added to next year's increase, and to the increase in every year thereafter. Not only this year's increase, but the greater-than-inflation increases of each prior year and of each future year are also added. In the past six years alone, the greater-than-inflation increase has been 61 percent.
September 11, 2007
California legislation set for veto and special session
In a classic example of political irony, Democrats are abandoning their preferred option, single payer reform, in order to reach a compromise with the Republicans and the private insurance industry. They have crafted a model that they believe does not repeat the mistake of the Massachusetts reform program. California Democrats proudly proclaim that they will not require individuals who cannot afford private insurance to be covered by a program that is being inappropriately characterized as universal.
September 10, 2007
AHIP/Milliman report on guaranteed issue and community rating
The implicit conclusion presented is that guaranteed issue and community rating should be rejected in order to "stabilize the insurance marketplace and provide consumers more choice and access to coverage." The problem is that this stabilizes the market only for healthy consumers.
September 07, 2007
Age related burden of out-of-pocket health spending
The results of this study are intuitive. Older individuals with greater health care needs and lower incomes spend a greater percentage of their incomes on health care than do younger, healthier individuals with higher incomes. But there are a couple of other extrapolations from this study that are also important.
September 05, 2007
More administrative services
As the government continues to ignore the health care financing crisis, the market responds - by selling us even more wasteful administrative services.
September 04, 2007
Uninsured by choice?
As anticipated, the opponents of comprehensive reform are framing the increase in the numbers of uninsured as a matter of personal choice for many.
August 31, 2007
ACS campaign on health insurance
The message of the American Cancer Society is clear. The most important single measure that would improve access to care that could save lives would be to provide everyone with comprehensive health insurance.
August 30, 2007
The moneylenders move in
Are these interest-free loans really free? Not when your complicit health care provider gives your cash discount of 10 percent to 25 percent to the moneylender, and you pay rack price. And it's especially not free when one late payment throws you into an exorbitant default rate.
August 29, 2007
Middle-income losing coverage
The public welfare programs continue to putter along. The dramatic decline in coverage has been primarily in employer-sponsored plans. Therefore it is no surprise that most of the 2 million plus individuals who lost coverage in 2006 were in the middle and upper-middle income sectors.
August 28, 2007
Census numbers of uninsured - only in America
The numbers to commit to memory: for 2006, 47.0 million were uninsured, which is 15.8 percent of the population.
These are the standard numbers used by the policy community to express the magnitude of the problem of the uninsured.
August 27, 2007
Will COBRA be there when you need it?
Another incremental improvement in health care coverage was the introduction of the COBRA regulations which allowed an individual to continue to purchase prior employer-sponsored coverage during limited transitional periods of unemployment.
One problem with the program is that many unemployed individuals simply are not able to pay the insurance premium and consequently lose their coverage.
August 24, 2007
Lewin Group analysis of Colorado proposals
Once again. The models of reform that build on our highly flawed, fragmented system of financing health care actually increase health care spending while falling far short on the goals of reform. In contrast, the single payer model would provide truly comprehensive care for absolutely everyone while significantly reducing health care spending.
August 23, 2007
Hudson's Chapin on health insurance
Whether we call Medicare "insurance" or "healthcare" is not really important. What is important is that we need to stop relying on private insurance and adopt a public program that is "permanent, portable, and simple and inexpensive to administer."
August 22, 2007
Californians shift views on reform
This poll does demonstrate a significant increase in the perceived dissatisfaction with the health care system in California in the past eight months, with the total dissatisfied increasing from 44% to 69%.
August 21, 2007
OECD report on private insurance impact on costs
As we address reform in the United States, high health care costs are a concern that we all share. This highly credible OECD report reveals that reform based on private health plans would add even more to our total health expenditure - not exactly the solution we seek.
August 20, 2007
Medicare fee reduction for ASCs
Why should Medicare pay higher prices for procedures done in a hospital outpatient setting than it does for procedures done in an efficient, free-standing ambulatory surgery center (ASC)? This is our tax money. Shouldn't we be receiving a better value?
August 17, 2007
The tragedy of a man throwing his ill wife off of their balcony
What a tragedy. None of us can really understand the desperation of this man that caused him to do this terrible thing. It is too easy for us to accept the media reports that he did this because of medical bills and no insurance to pay them. It is much more likely that his grief over her suffering was his primary motivating factor.
August 16, 2007
Was your $100 in drug marketing worth it?
The $30 billion spent by the pharmaceutical firms in promoting their drugs amounts to an astonishing $100 per each man, woman and child in the United States. That is a lot of money that must be built into the price of drugs. Are we receiving any value for this investment?
August 15, 2007
Medicare Advantage plan in receivership
Congress and the administration established the private sector Medicare Advantage plans to compete with the traditional Medicare program, arguing that the market is always more efficient than the government. Just to be certain that these private plans were successful, they were given an average of 12 percent more funds than were allocated for traditional Medicare. That wasn't enough of a buffer for this plan to avoid receivership.
August 14, 2007
Defining success for Illinois' All Kids
Illinois' All Kids was developed and promoted as a program that would provide health insurance coverage for all children in the state. A goal was set to cover 50,000 (one-fifth) of the uninsured children within the first year. This report celebrates the success of this program in that it achieved this target in only nine months. But is a celebration really warranted?
August 13, 2007
World's Best Medical Care? (New York Times)
We have the money. We should have "the best health care system in the world." But building on mediocrity will only bring us more mediocrity at ever greater levels of spending.
August 10, 2007
CMA testimony on Blue Cross
Wall Street analysts have continued to praise Blue Cross of California and its parent company (WellPoint) as being leaders in private insurance innovations that have led to stellar performances in the equities markets. Blue Cross/WellPoint has led, and in order to remain competitive, the others (including the non-profits) have followed.
August 09, 2007
WHO report on private insurance and cost sharing
Even though released three years ago, this primer on private health care funding of Western European countries is especially informative for the dialogue on health care reform now taking place in the United States.
August 08, 2007
For vaccines, underinsurance worse than no insurance
The crisis in the affordability of private health insurance can only result in an expansion in the current epidemic of underinsurance. If insurers are to maintain a market for their products, they must continue to find innovative methods of not paying for health care.
August 07, 2007
Children harmed by static SCHIP eligibility
If the politicians are serious about initiating comprehensive reform by covering all children, they must come up with a proposal that enrolls all children automatically and permanently. Watching them stumble around with the SCHIP program proves that building on our public and private plans will never get us there, and unfortunately most seemed resigned to that fact that we can't do it.
August 06, 2007
Consumer Reports on the underinsured
Private health plans work for people who do not and never will need health care. But what if medical needs arise? How well do they work?
August 03, 2007
The economics and morality of Sicko
The economic benefit of the single payer model is firmly established in the health policy literature. That does not stop the conservative and/or libertarian think tanks from using highly selected data to create the impression that there is a compelling economic argument for rejecting single payer reform. As David Felix's article suggests, these arguments are made to appear valid by remaining silent on the overwhelming body of information that would refute their deviously crafted premises.
August 02, 2007
Canadian Medical Association's proposal for Medicare Plus
Health Minister Tony Clement has rebuffed the Canadian Medical Association in its call for greater privatization of medicare.
Clement said the federal government will not allow so-called dual practice, which allows doctors to work in both the public and private health systems. In an interview, he referred to such an arrangement as a two-tier system.
August 01, 2007
Rudy Giuliani's health care proposal
Rudy Giuliani's choice of health care advisors is all you need to know to understand his positions on reform. His decision to trump rational health policy with extremist libertarian ideology does tend to make you question his political skills. He obviously isn't poll driven.
July 31, 2007
Presbyterian Health fought Whipple at M. D. Anderson
The appropriate medical decision could not be more straightforward. A Whipple procedure should always be done in a center with an experienced team. To attempt this operation at a local level with an inexperienced team is almost tantamount to a death sentence.
July 30, 2007
Single payer debate with AMA President-Elect Nancy Nielsen
I would like to mention one point of disagreement that could not be clarified during the limited time of the broadcast. I mentioned that the AMA's version of choice was the choice of private health plans, allowing individuals to purchase plans with lower premiums, but at a cost of reducing the insurance function of the private plans.
July 27, 2007
The best of the Blues
Those who believe that private insurers should continue to have a prominent role in health care financing often point to the Blue Cross and Blue Shield companies as effective, efficient and ethical insurers. How has that played out in California?
July 26, 2007
Lessons from Massachusetts on affordability
The issue of affordability was of primary concern from day one. But rather than addressing the crucial problem of the affordability of health care, the architects of the program decided to tackle the problem of the affordability of private insurance plans.
July 25, 2007
Queues in the U.S. - for the uninsured
The opponents of reform frequently claim that a program of national health insurance would introduce queues into the United States. But they're already here. As an example, for one quarter of the adult population in Los Angeles, excessive queues are already very much a fact of life.
July 23, 2007
UnitedHealth turns to public sector for profits
Those who still insist that health care reform cannot be achieved without continuing to include private insurers should take a closer look at this report.
UnitedHealth, the largest private health insurer, is having problems servicing the private commercial market and so is turning to our publicly financed programs.
July 19, 2007
Hospital consolidation increases disparities in insurance coverage
What is the purpose of our health care system? Is it to create successful business models that fulfill the goals of the American entrepreneurial spirit? Or is it to provide health care for all of the people of our nation?
July 18, 2007
Premium subsidies are not the answer
Amazing. Using government subsidies to cut health insurance premiums in half would reduce the numbers of uninsured by only 3 percent if participation were voluntary. The initial experience in Massachusetts also indicates that mandating participation, even with government subsidies and penalties for non-compliance, also fails to achieve universal health insurance coverage.
July 17, 2007
Health insurance for the 21st Century
Private health insurance was an idea that worked during part of the last century; it will not succeed through the 21st Century. With jobs increasingly service-based and short-term, the large employment-based risk pools that made this insurance system possible no longer exist. Medical care has become more effective and more essential to the ordinary person, but also more costly and capital-intensive. The multiple private insurance carriers that emerged during the last century can no longer provide a sound basis for financing our modern health care system.
July 16, 2007
Rationing under U.S. Medicare and Canadian Medicare
Paul Krugman's comments apply not only to hip replacement, but also to other queue problems reported in Canada, such as cataract surgery, cancer therapy, and non-urgent cardiac surgery. In the United States, these services are provided predominantly under Medicare, our public insurance program.
July 02, 2007
Keep your insurance and lose your doctor
Single payer opponents claim that the government would take away your choice of physician under a program of national health insurance. But do you lose your choice in the traditional, government-run Medicare program? Only if you sign up for a private insurance plan through Medicare Advantage are you limited in your choices of physicians.
June 29, 2007
Assets, debts and health insurance for middle-income families
This paper is an important addition to the dialogue on health care reform. Its primary contribution is that it demonstrates that middle-income families now have too few assets and too much debt to be able to tolerate the additional financial burden of out-of-pocket costs that result from plans with high-deductibles and reduced benefits - plans that are designed to keep premiums affordable.
June 28, 2007
The future is specialists and in-store clinics?
We know how to reduce waste while improving the overall quality of our system. We can eliminate a tremendous amount of administrative waste, due to our fragmented system of financing care, by changing to a single, efficient insurance system. We can improve quality and reduce costs by realigning incentives to support our rapidly deteriorating primary care infrastructure.
June 27, 2007
How many are uninsured?
This does not stop others from manipulating these numbers further. Conservative groups have suggested that many of the uninsured should be ignored for various reasons, and that the uninsured status is only of concern for less than 10 million individuals. Progressive groups have suggested that these counts understate the severity of the problem in that, over a two year period, more than 80 million individuals are without insurance at some point during that time.
Imaging as a proxy for government cost control
There have been some disturbing developments in medical imaging in recent years. There has been an increase in independent, entrepreneurial imaging centers which are not linked to hospitals. Specialty groups that order many scans frequently purchase their own units, providing physicians with even more incentives to order scans. This increased capacity has been demonstrated to increase the number of imaging procedures performed. Elliot Fisher and his Dartmouth colleagues have demonstrated that this increase in volume has not improved outcomes, yet it has decreased value of our Medicare purchasing. It is this over-utilization that is targeted by the reductions in Medicare rates for imaging services.
June 25, 2007
Political status of insurance mandates in California
The California Democratic leadership, Speaker Nunez and President Pro Tem Perata, introduced similar bills, with one very important difference. Though they both included an employer mandate, Perata's bill also included an individual mandate. When it was clear that you cannot require individuals to purchase a plan that they cannot afford, they agreed to drop the individual mandate. But that would leave a few million Californians without coverage.
The political priority of EMRs
Those politicians touting electronic medical records (EMRs) as a major component of their reform proposals should take note of this study. Diabetic patients in family practices that did not use EMRs received better care than those in family practices that did.
June 21, 2007
Woolhandler testimony on uninsured veterans
Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen uninsured veterans with untreated high blood pressure, diabetes and other conditions.
"It breaks my heart," she said.
June 20, 2007
PricewaterhouseCoopers on cost trends for 2008
When health care costs continue to increase well in excess of the rate of inflation, it seems counter-intuitive to celebrate the success of the role of consumerism in the deceleration of the rate of health care cost increases. Furthermore, is the celebration of the success of consumerism even warranted? Let's look at the four influences identified by PricewaterhouseCoopers.
June 19, 2007
Doctors agree that insurance matters
Most of us cringe when we hear a physician state that being uninsured doesn't prevent access to health care, noting that the emergency room is always available. This survey provides reassurance that most physicians do not share that view. When asked what the one single biggest impediment to access is, two-thirds of physicians state that it is the lack of health insurance. Though it is acknowledged that other factors are also important, being insured is absolutely crucial.
June 18, 2007
Blue Healthcare Bank
When they say it's not about the money, it's about the money.
June 15, 2007
Employers support competing market of benefit administrators
Most of America's largest employers are self-insured for their employee health benefit programs. Rather than insurers, they use benefit administrators in compliance with the Employee Retirement Income Security Act (ERISA), which are exempt from the requirements of state insurance regulators.
June 14, 2007
Actuarial values of individual coverage plummet
No surprise. As has been shown over and over, for average-income individuals either insurance premiums are unaffordable, or out-of-pocket expenses for health care are unaffordable (or both).
June 13, 2007
Why do nurses support Moore's Sicko?
Our nurses really do care about patients. They are in a unique position to recognize the tragedies caused by the barriers to care erected within our fragmented method of financing care, using a multitude of private insurance plans. The nurses have had it.
June 12, 2007
California's Battle of the Blues
If you want to know why the private insurance industry should no longer have a role in financing health care, just ask representatives of the private insurance industry to comment on their competitors.
June 11, 2007
WellPoint delivers on its promises (to Wall Street)
For those of us who continue to fight for comprehensive, affordable health care for everyone, listening to this webcast or reading the transcript is a very painful half-hour experience. WellPoint is 100 percent committed to "delivering on our financial promises to Wall Street."
June 08, 2007
Health insurance after divorce
Everyone should have health insurance coverage, automatically and permanently. It is wrong to require a link to extraneous qualifiers such as employment, location of residence, membership in organizations, age, or, in this instance, continuation of marriage to an individual with employer-sponsored coverage. Requiring such links satisfies the business model of the private insurers, but does so at the cost of leaving many without coverage. This remains one of the most serious flaws in our expensive, fragmented, and highly inequitable method of financing health care.
The Taming of the Queue IV
While Canada moves forward with queue management and fine tuning of capacity, we continue to hang our heads in shame over the financial barriers we place in front of tens of millions of Americans, which prevent access to the most generously funded health care system ever known. And we refuse to act because a humane system that covers everyone might expose us to the alleged threat of preventable queues?!
June 06, 2007
Blue Cross of California's $1 billion leak
If you read the "Undertakings" agreement you will see that it reflects an appropriate distrust of the private insurance industry, that it might not fulfill its responsibilities to its beneficiaries to see that they receive adequate coverage at a reasonable value. No such document would need to be created in a publicly-funded and publicly-administered insurance program. It represents yet more administrative waste resulting from keeping the private plans in play.
June 05, 2007
John Geyman on disease management
This article could not be timelier. In response to growing concerns about the affordability of health care, the political arena is awash with proposals to control health care spending. Unfortunately, because of the timidity of the politicians in confronting the powerful vested interests that are wasting so much of our resources, they are turning to pseudo-solutions such as the commercial variety of disease management.
June 04, 2007
Defining affordability of health care
Although there is no accepted economic definition of affordability, this paper makes an attempt to set an affordability standard for health care by defining what people are willfully paying for health insurance premiums plus out-of-pocket expenses in our voluntary private health insurance market. Presumably, the uninsured are individuals who find these costs to be unaffordable, and many objective studies confirm that the great majority of the uninsured simply do not have the funds to pay these costs.
May 25, 2007
Blue Cross commences health reform war
Blue Cross has led the way in excluding from coverage individuals with potential health risks, in rescissions for those who do submit claims, in shifting more costs to patients through aggressive marketing of high-deductible plans, in marketing stripped-down coverage such as the TONIK plans for the young invincibles, and in marketing strategies that avoid high-cost employer-sponsored groups.
May 24, 2007
Towers Perrin update on HSAs
Towers Perrin states that the future of [account-based health plans] ABHPs may be in question if employers do not clear up this alleged confusion on the part of their employees. It is much more likely that Towers Perrin is confused if they really believe that gaining support for ABHPs is merely a matter of employee education. In reality, the employees are not confused. They understand the effort to con them through this ABHP snow job, and they don't like it.
May 23, 2007
The AMA on Medicare Advantage
So the AMA supports adequate funding of the traditional Medicare program and opposes "a federal handout to the insurance industry," especially when the experience of physicians is failing to match the pro-market rhetoric of the private insurance industry.
May 22, 2007
All children, or everyone?
The SCHIP enrollment lessons are quite clear. If we really do want to have all children insured, enrollment must be completely automatic for every child. That will never happen with a fragmented system of multiple public and private plans with varying thresholds of eligibility and changes in eligibility status.
May 21, 2007
Health policy lessons from Indiana
Indiana likely will end up providing coverage for less than one-tenth of their uninsured residents, but with coverage that is inadequate and still unaffordable for most. Lack of a mechanism for automatic enrollment, continual changes in eligibility status, and a funding source which is capped will further destabilize the pool of individuals covered by this program. This patchwork program is not worthy of being labeled "reform."
May 18, 2007
California family physicians support single payer
Although this is not a scientific poll, it does demonstrate strong support by family physicians for single payer reform.
Feasible or not, the revolution is coming.
May 17, 2007
Regence BlueShield's bait-and-switch
Some years insurers will hold their premiums down in order to gain market share. After their enrollment increases and their competition is diminished, they then raise premiums sharply to recover deferred profits plus provide an additional generous profit margin for current insurance sales. Wall Street dignifies this process by calling it the insurance underwriting cycle, but it is nothing more than a devious bait-and-switch scheme.
May 16, 2007
Marsha Gold on Medicare Advantage and the market
Paying these private, fee-for-service Medicare Advantage plans 119 percent of the costs of the traditional Medicare program, and then pretending that this represents market competition, is utter nonsense.
U.S. health care ranks last again
To really understand this report, you do need to read it in full. Based on the performance measures surveyed, of the six nations studied, the United States does have the least equitable and most expensive system, and places last in overall ranking. Clearly, the American health care system is NOT the best in the world.
May 14, 2007
Blue Cross settlement on rescission
The purpose of rescission is to prevent individuals from obtaining a free ride by not purchasing insurance while they are healthy, but then purchasing it when a major problem develops. For insurance to work, the healthy have to pay into the risk pool to cover the costs of the sick.
May 11, 2007
New polls on universal, tax-supported health care
If these poll numbers were cast at the ballot box, this would constitute a clear mandate from the American public. So why do we keep hearing that national health insurance is not politically feasible?
May 10, 2007
Is SCHIP reauthorization enough for now?
About two-thirds of Americans now believe that we need comprehensive reform of health care financing to make health care affordable for everyone. Yet incrementalists, those currently in control of Congress, say that we should take care of children first. What politician would go on recored as opposing health care for children, especially when their health care costs are quite low?
May 09, 2007
EPO and market competition
In financing health care, the United States depends more on market forces while other nations utilize greater government oversight. The EPO story demonstrates that even physicians, when offered a legal, lucrative business deal, will modify their practice patterns to increase profit, even though those market incentives may work to the detriment of their patients' health. It is easy to ignore outcomes and talk about "healthier hemoglobins" when the financial rewards for doing so are great.
May 08, 2007
Private insurers depleting Medicare Trust Fund
In the traditional Medicare program, profits for health plans are not a consideration since middlemen do not even exist. Nor does the traditional Medicare program need to deal with marketing expenses and other superfluous administrative excesses.
Congress insists that private plans are necessary to help prevent the "bankruptcy" of the Medicare Hospital Insurance Trust Fund. Yet their private solution for a government problem, according to Medicare's own actuary, is speeding up the depletion of the Trust Fund.
May 07, 2007
Steve Burd's Coalition to Advance Healthcare Reform
Burd's proposal is an individual mandate to purchase unaffordable or inadequate private insurance, using regressive tax policies, with greater administrative excesses of care management programs, and it depends on the
fiction of consumer cost management through transparency.
April 28, 2007
Kennedy/Dingell Medicare for All Act
Congressman Dingell and Senator Kennedy for decades have been leaders in the effort to obtain comprehensive health care coverage for everyone. The introduction of their Medicare for All Act is a very welcome addition to the national dialogue on reform. Their proposal would result in a definite improvement over our current dysfunctional system of financing health care. That's the good news.
So what could be bad about this? Well, first a brief word about the respective roles of those of us involved in the health care reform movement. John Dingell and Ted Kennedy are politicians, in fact, master politicians. Their role is to negotiate the political process, carefully traversing the minefields, to make reform a reality.
April 27, 2007
Presidential candidates on health care reform
The American people are ready for reform. What we now need is leadership.
Only one of these leading candidates has a serious proposal for reform, and that is John Edwards. Of other candidates, Dennis Kucinich has a proposal that is already before Congress, HR 676, which has 67 cosponsors in the House. In fact, HR 676, by providing affordable, comprehensive health care for everyone, is the golden standard against which all other proposals should be judged.
April 26, 2007
Reinhardt does the math on HSAs
Dr. Reinhardt's objective analysis provides us with a more than adequate basis for booting from the forums on reform the HSA advocates who would require those feeling physical pain also feel fiscal pain. Once they are out of the way, we can then get serious about reform that actually benefits patients.
April 25, 2007
Small businesses support national health insurance
Small businesses have been struggling with the costs of health insurance, and the problem only grows worse. In fact, in the past 15 years, the percentage of small business owners even offering health insurance to their employees has dropped from two-thirds to two-fifths.
April 24, 2007
Wal-Mart's version of affordable access
The Wal-Mart clinics actually will improve accessibility to the limited services that they offer, and do so at affordable rates. But the clinics would further fragment services that should be provided at the primary care medical home. They skim off the easy, low-cost, bread-and-butter medical services that help pay the overhead expenses of primary care practices. They also fragment patients' medical records, such as creating uncertainty as to their immunization status, uncertainty in monitoring of their chronic diseases such as hypertension and diabetes, and uncertainty as to medication compliance and drug incompatibilities. These clinics threaten to accelerate the further demise of the medical home.
April 23, 2007
WellPoint advocates shift to underinsurance
To survive, the private insurers must continue to restrict their markets to the healthy, while supporting public policies that shift the real costs of health care to the taxpayers. Also, and this should set off alarms throughout our nation, they must continue to create more products that are affordable for the healthy by dramatically reducing the financial security that health insurance should be providing. Since their administrative costs are fixed or even increasing (selling new administrative products such as disease management, HSA administration, credit card services, etc.), the reduction in premiums must come from a greater reduction in benefits paid out for health care services.
April 20, 2007
Paul O'Neill wants an honest discussion on reform
It is refreshing to hear such words coming from a prominent Republican member of the business community. He is explicitly calling for providing health care to everyone (as a right), through a common health care fund (pool), paid for equitably (an obligation of the better off), and achieving it through an honest political process (give us the truth).
April 19, 2007
Employers flip labels in vending machines
Large employers do want to be relieved of the burden of very high health care costs. Most recognize that it will require a national solution, and that the government will have to play a significant role. The stumbling block is that they have not yet conceded that we must reform financing by adopting a universal program of social insurance, even though a national, government solution, by definition, is, basically, social insurance.
April 18, 2007
Canada controls costs without compromising health outcomes
The important policy lesson: Canada's government-funded and government-administered single payer system dramatically reduced their rate of health care cost increases without having a negative impact on health outcomes. The cost savings alone is a compelling reason to adopt a national health insurance program in the United States.
April 13, 2007
Andy Grove on electronic medical records
We can't allow the debate on health care reform to be hijacked by those who would suggest that electronic information systems are the answer, perhaps along with expanding the children's health insurance program.
When the politicians extol the virtues of information technology, remind them that they're off topic. They need to tell us how they would reform health care financing for all of us.
April 12, 2007
Jonathan Cohn pretends to oppose single payer
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