All posts by cidelson

Health Care

The Reform That, to the White House, Dare Not Speak Its Name

In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table.” — President Obama, opening the White House health care summit.

Except one idea, apparently. The one reform that will actually contain health care costs, cited by the President as his main goal, and, as a bonus, solve the healthcare crisis —  single payer, or expanding and upgrading Medicare to cover everyone.

In the weeks leading up to the summit, the White House made sure all the people it wanted in the room were there. The insurers, drug companies, corporate lobbyists, and those consumer and advocacy groups willing to play by the script.

One segment, however, was conspicuously absent, advocates of single payer reform. Who happen to include, nurses and doctors, the people who have the most daily experience with the collapsing health care system and who by large margins support single payer.

Why were they excluded? When the dean of the press corps, Helen Thomas, asked White House Press Secretary Robert Gibbs that question yesterday, he came up with this charmer:

MR. GIBBS:  I will certainly check on — I told Chip we rented a big room, but we didn’t get the Nationals’ baseball stadium.  

So despite their years of experience in fighting for real reform, the single payer proponents had to take to the streets (again), to pound their way in. Just a few hours before the meeting, and apparently hoping to head off the announced protest at the gates of the White House, invitations were hurriedly and belatedly extended to Rep. John Conyers, author of HR 676, the Medicare for all bill in Congress, and Oliver Fein, MD, president of the Physicians for a National Health Program.

Two seats out of some 120, not exactly a message of inclusion. And there was no space for their voices in the tightly scripted sessions.

As The Nation’s John Nichols wrote afterwards:

while the doctor was not included on any of the lists of breakout session speakers, the CEOs were, along with representatives of the U.S. Chamber of Commerce, America’s Health Insurance Plans, the Blue Cross Blue Shield Association and the Business Roundtable.

In other words, the overwhelming weight of opinion at what was supposed to be a wide-ranging discussion of health reform was — at best — on the side of tinkering with the existing for-profit system. Change we can believe in was not on the agenda.

http://www.thenation.com/blogs…

Maybe the redoubtable Mr. Gibbs can explain:



Helen Thomas:    Why is the President against single-payer?

MR. GIBBS:  The President doesn’t believe that’s the best way to achieve the goal of cutting costs and increasing access.  

Or perhaps there’s the reason suggested by Harper’s Magazine editor Luke Mitchell on Democracy Now this morning:

it’s a threat to a great deal of people who are making a lot of money right now, which is to say the insurance companies. A single-payer system would take a lot of money out of the insurance system, the private insurance system. And it’s also something that a lot of people in Washington understand as ideologically threatening,

http://www.democracynow.org/20…

And, as Democracy Now host Amy Goodman noted, the silence in the summit is largely echoed in the exclusion of single payer voices in the major media:

A new study being released today by FAIR, Fairness and Accuracy in Reporting, found the views of advocates of single payer have only been aired five times in the hundreds of major newspaper, broadcasts and cable stories about healthcare reform over the past week. No single-payer advocate has appeared on a major TV broadcast or cable network to talk about the policy during that period.  

It’s not single payer advocates who are harmed by this wall of exclusion, it’s all the American families and patients who yearn for real reform and will almost surely be disillusioned by proposals that fail to achieve it.

Because you can’t genuinely rein in costs without tackling them at the source — the insurance companies and their built in incentive to perennially jack up premiums, co-pays, deductibles and all the other ATM fees that are bankrupting families and crushing businesses. Nor can you begin to address the callous and routine denial of care for those already insured by the claims adjustors and bean counters who don’t want to pay for it.

There’s another potential casualty here as well, President Obama who himself famously said in 2003 that he was a proponent of single payer and must surely know it is the best approach. A lot of political capital will be expended to pass reform this year, it ought to be devoted to a reform that will actually work.

Health Care

Only One Healthcare Reform Will Control Costs — and Fix the Crisis

After eight dismal years of healthcare policy from an administration more interested in engorging the nation’s insurance and pharmaceutical industries, how refreshing to hear a State of the Union speech that calls for comprehensive reform and recognizes the real pain and suffering of American families priced out of access to care.

So President Obama deserves plaudits for his emphasis on healthcare reform, and pledge to getting it done this year amidst the deepening economic gloom.

But it won’t do our nation — or the President and Congress — any good to expend the political capital necessary to pass legislation unless we actually fix the problem.

And any bill, like so many of those short sighted proposals now being considered in several legislative committees, that leaves the insurance companies in control of our health won’t curb the rise in costs that are devastating families today or do anything about the now all too routine denials of care.

Only one reform, single-payer, or an expanded and upgraded Medicare for all, effectively controls costs at the source, by eliminating the stranglehold of the insurance giants and the price gouging we see in ever-rising premiums, co-pays, deductibles, and other daily costs that have caused so much harm to so many. A bill that gets us there, John Conyers’ HR 676, has been recently reintroduced in the House.

A report just out today from the Institute of Medicine reaffirms the problem, Markowitz noted. Average premiums for family coverage have soared by 119 percent the past decade – three and a half times the growth of family incomes.

The IOM noted that many companies are dumping full-time positions, and replacing them with part-time, contract, and temporary jobs that don’t offer health benefits. Also, more and more areas around the country are experiencing severe problems with limited hospital access to emergency care and in-patient bed capacity as the result of the growing number of uninsured and underinsured Americans.

There’s an added bonus. Single payer reform is that it not only guarantees coverage for everyone, controls costs, and ensures complete choice of provider — it also promotes economic recovery.

A recent study by the Institute for Health and Socio-Economic Policy (IHSP), research arm of the California Nurses Association/National Nurses Organizing Committee, finds that single payer reform would create 2.6 million new good paying jobs, infuse $317 billion in new business and public revenues, and inject another $100 billion in wages into the U.S. economy. The study may be viewed at www.CalNurses.org.

While 30 percent of the new jobs would be in health and social services, the ripple effect of job creation goes throughout the economy, with gains in retail trade, accommodation and food services, manufacturing, and administrative services, as well as healthcare.

Uncategorized

McCain’s latest words he’d probably like to take back

1 Comment

Sen. John McCain spent most of the last week trying to live down his pronouncement on the day of the stock market implosion that the “fundamentals of the economy are strong.”  

Looks like he has a new task for this coming week.  

In an article in the Sept./Oct. issue of Contingencies, the magazine of the American Academy of Actuaries, McCain wrote, “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.”

Obviously those words were crafted long before this week and McCain’s new found conversion to the notion that regulatory oversight in the financial markets at least might have some value after all.

But if the meltdown of our healthcare system is not as glaring as the cracks now running through Wall Street, they are no less severe for tens of millions of Americans.

At a time when one-fifth of Americans have told pollsters they self-ration needed care and people are wiping out their savings to pay medical bills, the healthcare crisis does not look like it could get much worse.

And it’s worth recalling the Commonwealth Fund study this summer that 101,000 fewer Americans would die if we matched other industrial countries in health care quality and access barometers.

How does all that relate to McCain’s dreamy notion that we should tether our healthcare system to the same “vigorous” forces that made our banking system so successful?

McCain’s prescription for healthcare is to further unleash the hand of the private market in health care, and remove the what few nettlesome fetters — public oversight protections — exist now.

To that end, McCain’s health care plan has two central components:

1- Move people from group plan coverage, as some 60 percent of Americans now get if they have employer-paid health plans, to the individual insurance market. How he gets there is to tax healthcare benefits for working people in hope that younger, healthier workers will give up their comprehensive coverage to go buy cheaper, less comprehensive plans with higher out of pocket costs on the individual market.

That accomplishes two things. First, it discourages individuals and families from using health care services that they have to pay more for, promoting even more self-rationing. Second, it undermines employer plans, as employers will be left with the more costly less healthy workers to cover. The result, intended of course, is to prod employers to scale way back in what coverage they offer or, more likely, eliminate coverage entirely.

To McCain, borrowing from the rightwing healthcare policy think tanks, this is the way to cut health care costs, by pushing more people out of the health care system, no matter how brutal and inhumane the results.

2- Wipe out existing minimum standards on insurance companies some states have adopted. The McCain plan would permit insurers to evade all requirements that have been won by nurses, and other healthcare activists, in states across the country.

In California, the list of minimum coverage insurers must provide, for example, include mammography, prostrate cancer screening, minimum maternity stays, independent medical review of care denials, hospice care, direct access to an OB/GYN, breast reconstruction, colorectal screening, AIDS vaccines, and diabetic supplies.

Not exactly frills, and most won against the bitter opposition of the insurance industry. The minimum maternity stays, to name one, followed a scandal of a series of reported infant deaths from jaundice in the 1990s as big insurers were increasingly kicking new moms and their babies out of the hospital just a few hours after birth. Presumably, that’s an example of the “worst excesses of state-based regulation” John McCain thinks we need to dump.

Uncategorized

McCain should spend less time talking about Paris Hilton and pay attention to the healthcare crisis

With all of his focus on Paris Hilton and Britney Spears, here’s some news that Sen. John McCain might have missed the past few days:

• Average patient waiting times in emergency rooms has increased to almost an hour in the past decade. The biggest jump in ER visits is not among the uninsured, but those with private insurance who are unable to get appointments for primary care.

• Across the country, nursing homes are evicting frail and ill residents mostly to bring in new patients who are more profitable to house.

• One third of uninsured adults has received a diagnosis of chronic disease like diabetes or high blood pressure, but are not getting adequate care.

• Drug companies are jacking up prices by 100 percent — and in some cases over 1,000 percent. “Some companies seem to figure no one is watching so they can get away with it,” said a researcher at the University of Minnesota which issued the report. Concurrently, the 25 biggest drug companies happened to make more than $100 billion in profits last year.

You don’t have to be reading arcane internet sites to find this news, all of which appeared in the first few days of August. They appeared prominently in the pages of the Wall Street Journal, USA Today, New York Times, Miami Herald, Kansas City Star, and other major media outlets.

So why does it seem that healthcare has dropped off the radar screen in the presidential race? Perhaps they have more important things to talk about, like McCain’s latest ad on how many magazine covers his opponent, Sen. Barack Obama appears on.

Or perhaps McCain would prefer to avoid talking about healthcare because his plan would solve none of the problems reported in the media this week alone.

McCain’s answer to our national healthcare nightmare includes:

Taxing medical benefits which would increase the taxable income on the very working people most suffering from the recession and high gas, food, medical bills, and job loss.

Further deregulating insurance companies by allowing them to evade current minimum standards established by some states on coverage and other public protections.

Tax credits for the uninsured to buy private insurance. Too bad that the annual credits he’s offering, $2,500 for individuals, $5,000 for families, is far below the current $12,000 average for insurance premiums.

Sen. Obama’s health plan goes much further in some respects. For example, he’d allow Americans to buy cheaper medications from other countries and repeal the Bush administration ban on the government using its bulk purchasing power to negotiate lower prices from drug companies.

But more is needed. A Commonwealth Fund report that also came out this week found that 82 percent of Americans believe the U.S. healthcare system needs to be completely rebuilt or fundamentally changed.

There’s only one way to do that. The type of national or single payer healthcare system in place in every other industrialized country.  

Also passing virtually unnoticed a week ago was the 43rd anniversary of Medicare which, as a CNA/NNOC ad noted, “changed the lives of millions.” Though it has been under a steady drumbeat of attack from the free market fundamentalists who fear the example it provides, it is still the least bureaucratic, most comprehensive healthcare program in the nation. It’s long past time to push for enactment of HR 676 to restore the original Medicare and expand it to cover everyone.  

Uncategorized

John McCain’s own “mental recession” on health care

OK, it’s easy enough to pile on ex-Sen. Phil Gramm for mocking the plight of Americans losing their homes by saying it is all a “mental recession.”

Of course, from the rarified environment Gramm rides around in, he’s probably not noticed the 59 percent of Americans who told a June Kaiser Health tracking poll that they are having a “serious problem” with paying for gas, getting a decent paying job, or health care or food bills.

But while John McCain tries to distance himself from the mess created by Gramm, one of his top economic advisers, the soon-to-be Republican nominee, seems to have his own let them eat cake perspective on one of the most critical issues of this campaign, health care.

It shouldn’t be much of a stretch to discover the deepening crisis on health care felt by so many American families. Take the June report in the Wall Street Journal, a paper the McCain team no doubt manages to read, citing a survey of 18,000 Americans who said they’d delayed or gone without needed medical care due to the cost.

Or the Robert Wood Johnson study in April showing premiums for families who get employer-sponsored health coverage have jumped 10 times faster than workers’ wages in this decade.

Or the New York Times report in June about the insurance companies that now reject the applications for coverage from women who’ve had c-section births.

But with our health care safety net collapsing and more people going without health coverage and self-rationing care, McCain seems to be frozen in the abysmal status quo. His healthcare plan offers little relief from the present morass, and, if anything, is likely to make the crisis worse.

McCain’s healthcare platform rests on four very wobbly legs:

Tax credits to encourage the uninsured to buy private insurance. But once a year tax credits are of minimal help for those living paycheck to paycheck, especially with no controls on ever skyrocketing premiums, co-pays, deductibles, doctor’s fees, and a mountain of other out-of-pocket costs.

Expanding federal support for state “high risk pools” as the dumping ground for people with pre-existing conditions (or, as Barbara Ehrenreich calls them, prior convictions) who the insurance companies refuse to sell policies to. But, in a devastating critique of this scheme this week, the New York Times noted that the state plans are largely a failure. Almost all impose long waiting periods, up to a year, before allowing you to enroll, and all have very high costs for getting in. Florida closed its pool in 1991, and the current membership is just 313 people, rather a small percentage of the state’s population. And, by the way, McCain has no proposal to pay for a federal expansion of this train wreck.

Eliminating the tax deduction for employer-sponsored coverage. The inevitable result will be to make health benefits less attractive to employers, meaning the decline of employer-based plans would become an avalanche — and far more risk and financial burden will be shifted to families and individuals who hardly need more financial worries in the present “mental recession,” as Phil Gramm puts it.

More deregulation of the insurance industry to encourage competition, McCain’s prescription for controlling the ever rising costs. It’s hard to imagine a more friendly administration to the avatars of deregulation than the one currently in office, during which premiums alone have gone up 78 percent the past six years for family coverage under employer plans, as the Atlanta Journal Constitution noted July 6.

Further, the notion that insurance companies compete by offering expanded access or reduced out-of-pocket costs requires much suspension of disbelief. Insurers compete by lowering their own costs, to increase company profits and shareholder return. How do they lower costs? By denying medical claims which they ghoulishly term “medical loss ratio,” dumping enrollees when they get sick, and reducing services that are covered.

Since he is so averse to regulation, it’s not surprising that McCain has nothing to offer the tens of thousands of patients and families grappling with insurance company decisions to deny medical procedures recommended by their doctors, or delay care, or reject diagnostic procedures or referrals to specialists, or impose higher charges for going “out-of-network.” Apparently those problems don’t even exist.

McCain hasn’t yet said the nation’s healthcare crisis is psychological, but it sure looks like all he’s offering are words of encouragement and placebos.