Mike Malloy

[Doc]

National Health Care Act worthy of public support



By BETH SIRR
Helena Independent Record
03/01/2009

Sick of health insurance costs? Then pay attention. Some in Congress want to perpetuate the power of insurance corporations over our health care and what we pay to get it. There is an alternative. The U.S. National Health Care Act: Expanded and Improved Medicare for All, HR 676 could be implemented within 13 months (like Medicare was) and unlike the Wall Street bailout, would be funded by eliminating waste while providing a real hand up for every American family and business — except the insurance industry.

HR 676 would save billions annually by eliminating the high overhead costs and profits of the private health insurance industry and HMOs. According to the Government Accountability Office, the Economic Policy Institute, and others a single-payer system saves enough to offset the costs of providing the health care, about $1.1 trillion. That is how other countries are under-spending, yet out-performing us in health care.

HR 676 would expand an improved Medicare as the publicly accountable “insurance” payer for all of us. Doctors would remain in private practice providing our care. Patients would be free to seek care with the doctor or hospital of their choice.

HR 676 would cover every person in the U. S. for all necessary medical care including
prescription drugs,
hospital,
surgical,
outpatient services,
primary and preventive care,
emergency services,
dental,
mental health,
home health,
physical therapy,
rehabilitation (including for substance abuse),
vision care,
chiropractic
and long term care.

In the 110th Congress, HR 676 had 93 co-sponsors in addition to its sponsor Rep. Conyers.

HR 676 has been endorsed by the U.S. Conference of Mayors, Physicians for a National Health Program, 480 union organizations in 49 states including 118 Central Labor Councils and Area Labor Federations and 39 AFL-CIO’s (including Montana).

HR 676, as part of its funding, calls for a modest increase in payroll taxes to replace insurance premiums, and economists estimate that both businesses and individuals would pay less than they do now.

Is there support for such reforms? Oh yes! In 2008, the National Federation of Independent Business survey found a majority of businesses polled preferred a payroll tax to fund employee health care rather than our current insurance system. Large independent polls also find a majority (64-65 percent) of Americans support a federally funded single payer approach to health care (AP/Yahoo, CBS News/New York Times, Harvard School of Public Health, and CNN, 2007-2008). People are ready for reform — now for the politicians!

Senator Baucus needs to hear that we don’t need or want a health care plan like the expensive and complicated Medicare drug plan. Ask Senator Baucus to put the greatest public good ahead of corporate profits — ask him to set aside his white paper and sponsor HR 676 in the Senate. Call him at: (800) 828-0498 or (800) 332-6106, or come March 1 at 6 p.m. to the YWCA on Park Avenue to hear Bob Putsch, M.D. “Making Sense of Health Care Reform,” to learn more.

Beth Sirr is a family nurse practitioner in Helena.

[Doc]

President Obama,

What Happened to Openess and Transparency?

Recent polling indicates a super-majority of Americans want a national healthcare system. Both you and your Secretary of Health and Human Services have publicly stated support for single-payer healthcare, yet at your healthcare reform meeting on March 5, not one single-payer advocate has been invited to the table.

Single-payer healthcare is the solution to what ails us.

I welcomed your promise to clean-up Washington. The healthcare corporations have made billions of dollars for their CEOs and stockholders at the expense of ordinary working Americans for years, and they have used that money to make generous contributions to candidates and office-holders. Are you afraid of them while you have the majority of Americans covering your back?

You have a strong ally in Rep. John Conyers, the leading proponent of single-payer healthcare in Congress. Please invite him to attend the March 5 meeting.

Sincerely,
Your Name

[Doc]

The reason given for even considering rationing of emergency room beds demonstrates just how sick our health care financing system is. They would increase the overload of the emergency room to a level that would drive away low income populations so that they would not have to admit those who are "so acutely ill that they must be transferred to general-medicine or intensive-care wards" within their hospital. Just to be sure, they would reduce those acute in-patient beds as well. At the same time that they would create deliberate rationing for acutely ill, low-income individuals, they would expand their bed capacity for lucrative services for insured patients.

Sick, sick, sick!

This isn't about a lack of money, because we already spend more than enough to pay for these services. This is about the way we finance health care. The uninsured and those in the under-funded Medicaid program are a drain on resources, and it is understandable that the administrators would want to reduce that drain. But our sick system of financing care leads them to the consideration of truly perverse methods of reducing that burden.

The current leading proposal to expand our fragmented, dysfunctional system of financing health care will not correct the perversities of a multi-tiered system. But imagine if we re-directed the $2.5 trillion that we are already spending into a single payer national health program, these perversities would be sharply curtailed. Health delivery system design would be based on patient needs rather than on the nature and distribution of the financing sources. Can't those in Washington working on reform understand this? It's not that complicated of a concept.

[Doc]

WHO’S MAKING OUR MEDICINE?
Thursday, February 26, 2009
Jim Hightower


Let’s talk pills. To treat everything from allergies to heart problems, half of Americans take a prescription medicine every day, and nearly all of us reach for the pill bottle on occasion.

It's perfectly safe, though, because the Food and Drug Administration regulates the ingredients that go into those medicinal compounds, right? Yes – assuming they’re produced in the USA.

Uh, aren’t they?

Mostly, no. Take antibiotics. The New York Times reports that ingredients for the majority of these bacteria fighters are "now made almost exclusively in China and India,” as are the components of dozens of other major drugs. Unbeknownst to most Americans (and to our doctors), China has become the world’s pre-eminent supplier of medicines. As one major drug company puts it: “If tomorrow China stopped supplying pharmaceutical ingredients, the worldwide pharmaceutical industry would collapse.”

What's at work here is mindless globalization and deregulation. Our politicians threw open the US market to drug imports, while also letting foreign manufacturers go uninspected and unregulated. So, companies located in China can cut corners and undercut our own regulated pill makers. America’s last producer of penicillin’s ingredients, for example, shut down in 2004, leaving us dependent on China.

FDA – our supposed watchdog – doesn’t even know where a drug’s ingredients come from. Why? Because drug companies say they don’t like to reveal their sources – so they don’t. The Times found that one federal database lists the existence of about 3,000 foreign drug plants that ship to the US, while another lists 6,800. No one knows which is correct, if either.

This is ridiculous. For the sake of America’s health, security, and economy, let’s regulate all pill makers and rebuild our own industry.

.

[Doc]

Yesterday, March 4, Congressman Raúl M. Grijalva released the following statement regarding President Obama’s Health Summit and the release of a timeline for health care reform:

“We are seeing a lot of positive movement in Washington on health care reform. Today, Senator Max Baucus and Representative Henry Waxman put forth a timeline to pass health care reform through Congress before the August Recess. Tomorrow, President Obama will host a summit on health care reform. This health summit begins an important dialogue that should include all voices and all viewpoints within the health care debate. Specifically, I am interested in ensuring that the concept of a “single-payer” health care system is part of this dialogue.

“I am pleased that Representative John Conyers has been invited to the President’s summit and that he will represent the concerns of many of us who support a single-payer concept. Although Rep. Conyers will be the sole, supporting voice at tomorrow’s gathering, he will be a strong voice. His presence will ensure that all proposals are on the table, especially the single-payer concept, which has such tremendous community support.”

[Doc]

Responding to those flaws, Fein, a practicing physician and professor of public health at Weill Cornell Medical College in New York, said health coverage must be universal, covering everyone. As for undocumented immigrants, he proposed the wording of any new health insurance law should stipulate that “residents” are covered, but then lawmakers should decide what length of residency is required to be eligible for coverage.

Fein enumerated other requirements of a new paradigm of health insurance. “It must be comprehensive. Would there be any exclusions? Yeah, probably, you know, tummy tucks, botox for wrinkles. I might even exclude a private room in the hospital unless medically indicated,” such as if a patient has a roommate with tuberculosis.

“It must be tier-free. Now we have one tier for the elderly, another tier for the poor, another tier for those who are employed, another for those who are uninsured. We really need to think of a single tier of care.”

That’s when he proposed eliminating co-pays and deductibles, “because what they do is cut demand for needed services equal to the amount they cut for unneeded services.” Another tenet of a tier-free system, he said, is that private insurance can supplement, but not duplicate, public coverage.

He said public funding should replace the “regressive” funding of premium-based financing for health insurance. “Right now, the president of a company usually pays the same premium as the secretary in the company. Are their incomes equal? Absolutely not.”

And finally, the new system must have low administrative costs, for which the U.S. has to look no further than its own health care program for elders. “Medicare has an administrative cost of three percent,” he pointed out, “whereas the average commercial insurance in this country has an overhead and profit of roughly 19 to 20 percent.” For some insurers, that number goes up to 30 percent of medical costs.

[Wild Bill]

I am for universal healthcare but it must be the same for everybody, especially the people who so much believe in it. No private plans available to rich pols such as Nancy Pelosi. If you have to wait for 9 months for an MRI, so be it. If the Liberals truly believe this system will work,then go ahead. Just don't use my tax dollars to pay for it and then you decide you should have superior healthcare because you can afford it.

[Doc]

When you've been strong and fit your whole life, it can be easy to discount your body's first whispers of sickness as merely the side effects of daily living. Looking back over the past three years, my older brother Patrick now understands the meaning of his increasingly frequent bouts of fatigue, his fluctuating appetite and the fact that his blood pressure had crept up to 150/90. But Pat had always put off going to the doctor until he had to. Having bought health insurance that carried a $2,500 deductible, he knew he would have to pay for a checkup himself. That is no small consideration for someone who makes $9 an hour, as my brother did in his job as an administrative assistant for a lighting firm in San Antonio. He also struggles with Asperger's syndrome, a disorder sometimes described as high-functioning autism. Pat can multiply three-digit numbers in his head with ease, but he has trouble accepting the unfamiliar and adjusting to the unforeseen.

The unforeseen was exactly what turned up when Pat went in for a physical on Nov. 30, 2007, his first in five years. The doctor found high levels of blood and protein in his urine, results that were confirmed in another round of tests in December. Soon after that, Pat discovered that his urine had turned brown and foamy. In the middle of all this, he was laid off from his job, and finding a new one while doing temp work was his most pressing concern. Finally, last July my brother's doctor insisted that he see a specialist, who quickly ordered a biopsy. That's when Pat, who is now 54, learned that his kidneys were failing.

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford."

Kidney failure would seem to be one of those disastrous "unexpected illnesses" that Pat thought he was insuring himself against. But apparently he was wrong. When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue.

Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere. That's when I realized that the national crisis I'd written so much about had just hit home.

Pat's story continues at this link:
http://www.time.com/time/nation/article/0,8599,1883149,00.html

And...

Kaiser Family Foundation
March 3, 2009
Health Care Reform Newsmaker Series: Sen. Max Baucus (D-MT)

Q&A

KAREN TUMULTY: Karen Tumulty from Time Magazine. What about, I mean, the concepts that are in a number of plans including yours – would allow people to buy into a Medicare program or a Medicare-like program? You say nothing is off the table, I mean, where does single payer fit in to all of this?

SEN. MAX BAUCUS (D-MT): I think single pay – Merck is not ready for single pay. I mean, America. We are a bit different than people in other countries. We are not Europe. We are not Canada. We are America. It is “go west, young man.” It is entrepreneurialism. It is creativity. It is innovation and so forth. And I think we have come up with a uniquely American solution which is a combination of public and private, because we are America. I think that we would be spending capital inefficiently by trying to pursue a single pay system when we have another pathway to meet the health care reform available to us.

I think it should be about choice, flexibility in our reform package, and I think this country does not want single pay. This is not a single pay country. Some suggest it, but I don’t think it’s there. I think we could make better use of our time trying to enact meaningful comprehensive reform basically along the lines of the white paper which is very similar to what President Obama is suggesting. It is somewhat similar to the Massachusetts plan, and that, I think, is a better use of our time.

http://www.kff.org/uninsured/030309reformpkg.cfm


Comment: Karen Tumulty already knew that our health insurance system was not functioning adequately for too many of us. She knew her brother, Patrick, was vulnerable considering his low income and the $2500 deductible on his health insurance policy. But even Karen Tumulty was caught off guard when she learned of the extremes of insurer innovation in the design of her brother's coverage.

Assurant Health was selling him six month policies in succession, not pointing out to him that each policy was a new policy that excluded preexisting disorders, even if they developed while he had the same coverage. The story that Karen tells in the rest of this article made her realize more than ever the need for comprehensive health care financing reform.

It is no wonder that she asked Sen. Max Baucus where single payer fits into all of this. If we had a single payer system, her brother would not have had to face all of the financial challenges that were caused by his very unfortunate medical circumstances. Do you think she was satisfied with his answer?

According to the Center for Responsive Politics, during 2003-2008, Max Baucus received $588,185 from the insurance industry and $523,313 from the pharmaceutical/health product industry.

As he brushed off single payer proclaiming that he has a uniquely American solution, do you think it was a Freudian slip when he said, "Merck is not ready for single pay. I mean, America."? Naw. Merck isn't ready, but America is.

[Doc]

Study finds universal health care would cost less than bailouts
03/01/2009 @ 10:25 pm
by Joe Byrne


The biggest obstacle to an enhanced national health care system wouldn't be money, a study conducted by the Institute for Health and Socio-economic Policy found. The transformation of America's current health care system into a single-payer 'Medicare for all' system could cost six times less than the bank bailouts.

This week, Barack Obama is expected to start movement on an ambitious overhaul of the country's health care system. Previous attempts at reform by FDR, Truman, Kennedy, Johnson, and Clinton have proved largely unsuccessful. 46 million Americans are without insurance, ABC reports, and the US spends twice as much on health care than the average developed nation, most of which work with universal health care. Critics of the current system point to the government treating health care as if it was a commodity, not a social service; because of the demands of the market, insurance companies have a motivation to avoid unprofitable patients.

Obama's plan, to be laid out in detail this week, will cost $634b out of the new overall budget. In addition, $175b that was to be payment to private insurers for the coverage of 10 million Medicare patients will be re-allocated over the next ten years' for health care reform.

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. The Institute for Health and Socio-economic Policy(IHSP) is a non-profit research group for the National Nurses Organizing Committee. According to the analysis of their proposal for a single-payer universal health care system, IHSP found that “full medicare benefits for all” would have these immediate effects:

* $317 billion in increased business and public revenues throughout the US economy.

* 2,613,495 new permanent jobs, at an average of $38,262 per year.

* $100 billion in additional employee compensation.

* $44 billion in increased tax revenue.

The biggest impact of the proposal would be coverage for the 46 million uninsured Americans, but 'Medicare for all' would also get rid of the “current chaos of eligibility, exclusions, family coverage, premium costs, and high out-of-pocket expense,” unenviable consequences of the present system.

A similar proposal for single-payer national health insurance was published by the American Medical Association in 2003. That study found that national health insurance would save the US $200b by “eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services.”

[Doc]

www.calnurses.org 011607

Healthcare Facts
Top 10 Reasons For Enacting a Single Payer Healthcare System

1. Everybody in,nobody out. Universal means access to healthcare for everyone, period — the desire of 81% of all Californians, as reported in a January, 2007 Field Poll.

2. Portability. Even if you are unemployed, or lose or change your job, your health coverage goes with you.

3. Uniform benefits. No Cadillac plans for the wealthy and Moped plans for everyone else, with high deductibles, limited services, caps on payments for care, and no protection in the event of a catastrophe. One level of comprehensive care no matter what size your wallet.

4. Prevention. By removing financial roadblocks, a single payer system encourages preventive care that lowers an individual’s ultimate cost and pain and suffering when problems are neglected, and societal cost in the over utilization of emergency rooms or the spread of communicable diseases.

5. Choice of physician. Most private plans restrict what doctors, other caregivers, or hospital you can use. Under a single payer system, patients have a choice, and the provider is assured a fair reimbursement.

6. Ending insurance industry interference with care. Caregivers and patients regain the autonomy to make decisions on what’s best for a patient’s health, not what’s dictated by the billing department or the bean counters. No denial of coverage due to pre-existing conditions or cancellation of policies for “unreported” minor health problems.

7. Reducing administrative waste. One third of every health care dollar in California goes for paperwork, such as denying care, and profits, compared to about 3% under Medicare, a single-payer, universal system.

8. Cost savings. A single payer system would produce the savings needed to cover everyone, largely by using existing resources without the waste. Taiwan, shifting from a U.S. healthcare model, adopted a single-payer system in 1995, boosting health coverage from 57% to 97% with little if any increase in overall healthcare spending.

9. Common sense budgeting. The public system sets fair reimbursements applied equally to all providers while assuring all comprehensive and appropriate health care is delivered, and uses its clout to negotiate volume discounts for prescription drugs and medical equipment.

10. Public oversight. The public sets the policies and administers the system, not high priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or stock wealth or company profits.
www.nnoc.net

[Doc]

FAIR Study: Media Blackout on Single-Payer Healthcare
Proponents of popular policy shut out of debate

3/6/09

Major newspaper, broadcast and cable stories mentioning healthcare reform in the week leading up to President Barack Obama's March 5 healthcare summit rarely mentioned the idea of a single-payer national health insurance program, according to a new FAIR study. And advocates of such a system--two of whom participated in yesterday's summit--were almost entirely shut out, FAIR found.

Single-payer--a model in which healthcare delivery would remain largely private, but would be paid for by a single federal health insurance fund (much like Medicare provides for seniors, and comparable to Canada's current system)--polls well with the public, who preferred it two-to-one over a privatized system in a recent survey (New York Times/CBS, 1/11-15/09). But a media consumer in the week leading up to the summit was more likely to read about single-payer from the hostile perspective of conservative columnist Charles Krauthammer than see an op-ed by a single-payer advocate in a major U.S. newspaper.

Over the past week, hundreds of stories in major newspapers and on NBC News, ABC News, CBS News, Fox News, CNN, MSNBC, NPR and PBS's NewsHour With Jim Lehrer mentioned healthcare reform, according to a search of the Nexis database (2/25/09-3/4/09). Yet all but 18 of these stories made no mention of "single-payer" (or synonyms commonly used by its proponents, such as "Medicare for all," or the proposed single-payer bill, H.R. 676), and only five included the views of advocates of single-payer--none of which appeared on television.

Of a total of 10 newspaper columns FAIR found that mentioned single-payer, Krauthammer's syndicated column critical of the concept, published in the Washington Post (2/27/09) and reprinted in four other daily newspapers, accounted for five instances. Only three columns in the study period advocated for a single-payer system (San Diego Union-Tribune, 2/26/09; Boston Globe, 3/1/09; St. Petersburg Times, 3/3/09).

The FAIR study turned up only three mentions of single-payer on the TV outlets surveyed, and two of those references were by TV guests who expressed strong disapproval of it: conservative New York Times columnist David Brooks (NewsHour, 2/27/09) and Republican congressman Darrell Issa (MSNBC's Hardball, 2/26/09).

In many newspapers, the only argument in favor of the policy has been made in letters to the editor (Oregonian, 2/28/09; USA Today, 2/26/09; Washington Post, 3/4/09; Philadelphia Inquirer, 2/27/09; Atlanta Journal Constitution, 2/26/09).

In contrast, the terminology of choice for detractors of any greater public-sector role in healthcare--such as "socialized medicine" and "government-run" healthcare--turned up seven times on TV, including once on ABC News's This Week (3/1/09) and five times on CNN. CNN senior medical correspondent Elizabeth Cohen has herself adopted this terminology in discussing healthcare reform, stating (CNN Newsroom, 2/26/09) that "if in time, Americans start to think what President Obama is proposing is some kind of government-run health system--a la Canada, a la England--he will get resistance in the same way that Hillary Clinton got resistance when she tried to do tried to do this in the '90s."

Particularly in the absence of actual coverage of single-payer, such rhetoric confuses rather than informs, blurring the differences between the Canadian model of government-administered national health insurance coupled with private healthcare delivery that single-payer proponents advocate, and healthcare systems such as Britain's, in which healthcare (and not just healthcare insurance) is administered by the government.

The views of CNN's senior medical correspondent notwithstanding, opinion polling (e.g., ABC News/Washington Post, 10/9-19/03) suggests that the public would actually favor single-payer.

Though more than 60 lawmakers have co-sponsored H.R. 676, the single-payer bill in Congress, Obama has not expressed support for single-payer; both the idea and its advocates were marginalized in yesterday's healthcare forum. But given the high level of popular support the policy enjoys, that's all the more reason media should include it in the public debate about the future of healthcare.

[SocialistScott]

[Doc]

[Doc]

Single-payer isn't socialism
Seattle Post-Intelligencer
February 27, 2008

As a long-time Seattle physician, I was pleased that the P-I supports health care reform toward a single-payer system (Opinion, Wednesday). Most Americans now fully understand that our health care delivery system is too expensive, too complex, too fragmented and overwhelmingly frustrating. Although some still believe that America has the best health care in the world, the truth is that our reimbursement system is killing us. The “health” of a country’s healthcare system can be inferred by looking at how we treat our most precious citizens: our children. International ranking of infant mortality by our own CIA now places the United States at 42 out of 222 countries, behind Hong Kong, Portugal, Korea, Macau, most of Europe and Cuba! In 1989, the United States was ranked at 19th. To allow this decline to continue is a moral outrage.

Many fear that a single-payer model is “Socialized Medicine.” In fact, a single simplified health care finance system is good for business. Our employment-linked health insurance system may have worked fine during the Cold War era, but today it is crippling American business. Businesses leaders and labor unions understand that shifting to a government-sponsored single-payer system isn’t a form of socialism. It is a more cost-effective, fair and universal system that can help restore our ability to compete in today’s international market place. This will preserve American business and American jobs.

Lastly, some fear universal healthcare would lead to rationing of benefits. But rationing is already being done by our insurance industry disguised under the euphemism of “medical necessity” or “covered service.” I am outraged when my patients tell me they can not get the medication or treatment they need because their insurance company will not cover it and they can not afford to pay out of pocket. It is time for our leaders to put aside fear and radically transform our healthcare finance system toward a single-payer system for our children and our future. It is economically and morally the healthy step to take.

B. Jason MacLurg, M.D.
Seattle, WA

[DavidNM]

A-Men Doc!!!

My wife is also a Dr. and we recently closed her medical practice because the blank blank insurance companies nearly put us out of business with their games, unwillingness to pay claims, please send us a form to order the form to challenge the denial, etc. . . Patients often were denied the care they needed / deserved - it's one big mess -- and that's for the people who HAVE insurance. I recently heard the statistic that appx 75% of the tens of thousands of people who have to declare bankruptcy because of medical bills HAVE insurance - but weren't getting covered.

If anyone out there hasn't seen the movie "Sicko" please rent it. I watch it every month or so to remind me of the mess we're in. We actually considered leaving the USA so my wife could practice in a country that had universal coverage - so she could focus on the science of medicine - helping people to get well instead of the BS of running a medical practice (we ended up going to a rural under-served area of the country).

I would gladly pay an additional 10% income tax in order to have universal health care and free access to a college education for all. But we probably wouldn't need to spend that much if this country got it's collective act together and did the right thing.

[Doc]

[Spitfire of ATJ]

[Doc]

Many are skipping medical, dental visits because of financial concerns




More than three-quarters of adult Americans who have health insurance say they still worry about paying more for their medical care, and nearly 50 percent say they’re “very” or “extremely” worried about the issue, a new Harris Interactive/HealthDay poll shows.

More than half (57 percent) of those polled said they feared losing their health insurance sometime in the future, which may explain another key finding in the poll — sizeable numbers of Americans said they’re skipping doctor visits or not getting prescriptions filled to save money.

Middle-aged Americans — people too old to be blasé about their health but too young to be covered by Medicare — seemed most worried about paying their health care bills. Among insured individuals aged 45 to 64, a full 84 percent said they were concerned that rising health care costs would exceed their ability to pay.

Only 8 percent of all insured Americans polled were “not at all worried” about getting health care coverage.

“Many are, in fact, not filling prescriptions, skipping a doctor’s visit, not following up on something that was recommended by the doctor, taking a medication less or pill-splitting, doing without dental care,” said Humphrey Taylor, chairman of The Harris Poll.

He added that with the economy in a tailspin and many Americans losing their employer-based health insurance, the problem may only get worse. “If the number of uninsured rises sharply, one would expect to see these numbers increase,” Taylor said.

One consumer advocate wasn’t surprised by the results of the poll, which included 2,078 adults surveyed between Feb. 25 and 27.

“Even for people who have insurance, increasingly, the costs have been shifted to them — and those costs have risen,” said Carol Pryor, policy director at The Access Project, a nonprofit group dedicated to making health care available to more Americans. More and more, she added, insured Americans are paying higher deductibles and co-pays, stretching their ability to get proper medical care.

Pryor agreed with Taylor that the situation is only likely to get worse, since “more people are becoming uninsured as a result of the economic meltdown.”

Some other key findings from the poll:

* 78 percent of adults with health insurance worry about paying more for their medical care.
* Nearly two-thirds (65 percent) of all insured adults say they’re worried about how they can afford to pay for medical care and prescription drugs, with that number rising to 76 percent among people aged 45 to 54. Even among those aged 65 and over — most of whom are eligible for Medicare — 62 percent say they worry about paying for the care they need.
* Over the past year, one in five insured adults skipped filling a prescription because of the cost. That number jumped to 30 percent for those without insurance.
* Similarly, cost concerns led 24 percent of the insured and 51 percent of the uninsured to forgo seeing a doctor for a specific medical problem. Twenty-one percent of the insured and 33 percent of the uninsured didn’t get a recommended follow-up test or treatment for the same reason.
* Trying to cut down on medical expenses, 14 percent of the insured and 19 percent of the uninsured took a medication at a lower dose than that recommended by a doctor.
* Dental care took the biggest hit: 51 percent of the uninsured and 30 percent of the insured skipped necessary dental care over the past year due to financial concerns.

Forgoing care to save costs over the short term may not save costs over the long term, the experts warned. “Some things do go away on their own over time,” Pryor said. “But there are a lot of conditions that get worse if they aren’t treated, and they then require more expensive care later. So it’s definitely a gamble.”

Taylor noted that the statistics on the percentage of Americans skipping needed care have remained about the same since 2007, when Harris first asked these types of questions. That may seem odd given the recent downturn in the economy, he added. But, he noted that even if a few million Americans lose their health insurance, that’s still only 2 percent of the adult population — not enough to show up in this type of survey.

The new poll results come on the heels of a report released Wednesday by the nonprofit advocacy group Families USA. It found that a third of Americans under the age of 65 — nearly 87 million people — went without health care coverage at some point over the past two years.

The most recent U.S. government statistics suggest that 16 percent of all adults (including those 65 and older) have no health insurance. And a Commonwealth Fund report published last June found that the number of “underinsured” — people who have insurance that doesn’t fully meet their health care needs — rose by 60 percent between 2003 and 2007.

The issue gained momentum in the nation’s capitol last Thursday, when President Barack Obama convened a long-anticipated White House summit on health care reform. The Associated Press reported that Obama made a point of bringing a wide range of views to the table — voices representing the insurance industry, patient groups, physicians and even those advocating a single-payer system.

“Every voice has to be heard. Every idea must be considered,” Obama said during the summit. “The status quo is the one option that is not on the table.”

According to Pryor, one item that should be up for discussion in Washington is the plight of the underinsured.

“Covering the uninsured is only part of the problem,” she said. “Unless reform includes adequate, comprehensive and affordable coverage, just having insurance will not be protection — either from facing barriers to care or concern over one’s financial stability. And after all, those two things are the function of insurance.”

[Doc]

Competing Views of Government: Universal Medicare or Government-Protected Insurance Companies

Monday 09 March 2009
by: Dean Baker, t r u t h o u t | Perspective


A doctor reviewing a patient board.

We all know that people have different ideologies about the proper role of government. Some people, who tend to be left of center, think that the government's role is to try to promote the general good, by providing basic services, protecting the poor and the sick, and ensuring a well-working economy. On the other hand, there are others, who usually place themselves right of center, who believe that the proper role of government is to redistribute as much income as possible to the wealthy.

These competing views of government are coming to a head in the debate over national health care reform. Those who think that the role of government is to serve the public good are likely to favor some form of universal Medicare. Such a system would almost certainly save a huge amount in administrative costs at the level of insurers, providers and government oversight.

Private insurers spend more than 15 percent of the money they collect in premiums on administrative costs. By contrast, Medicare spends about 2 percent. Part of the insurers' administrative expenses go toward marketing - an expense that would be unnecessary in a universal Medicare system.

The other major factor driving administrative costs with private insurers is associated with their efforts to game the system. Gaming is the best way to make profits in the current system. If insurers can find effective mechanisms for either keeping sick people from being insured, or finding ways to deny coverage for expensive care, then they stand to make large profits. Naturally, profit-maximizing insurers will therefore devote substantial resources to trying to avoid ways to provide health care to people who need it.

At the level of providers, the wide range of divergent forms and policies employs hundreds of thousands of people in administrative positions in hospitals, doctors' offices, nursing homes and other providers. These people are often quite adept at dealing with various insurers, which is an important skill in our current system, but a task that would disappear if we had a universal Medicare system.

Finally, the state and federal governments must devote substantial resources for oversight to police the practice of insurers. Oversight agencies are essential for limiting abuse. This task would be much simpler if there were not corporations that stood to profit by keeping people from getting needed care.

While we could in principle shift to a universal Medicare system immediately, this would be an extremely difficult task politically and would present some serious practical problems as well. During his campaign, President Obama proposed something far more modest: give employers and individuals the choice to buy into a public Medicare-type program. Under this system, if people are happy with their current health care insurance, they would have the option to keep it. However, if they decided that the plan offered by the government was better, they could buy into it.

In this situation, insurers would compete with the government plan in the market. If private insurers could offer health insurance that provided better coverage or charged less, then people would have the option to buy into a private plan. Of course, the government would also regulate the market so that private insurers could not cherry-pick their way to profitability by insuring only healthy people and dumping them when they became sick.

The insurance industry already recognizes that it will lose out in this sort of competition. A government-run plan will be more efficient. We already know this based on the experience with Medicare. When private insurers have competed side by side with the traditional government Medicare plan, in the absence of government subsidies, the overwhelming majority of beneficiaries opted to go with the traditional Medicare plan.

This is why the insurers are yelling that they don't want to face "unfair" competition from a government plan. But, their complaint should be all the endorsement that the public needs to support a public Medicare-type plan. The public plan will be cheaper and better than what the private insurers have to offer. Why shouldn't the public then have this option?

We all know that the insurance industry executives and the company shareholders want to make lots of money, but maybe they should try to find an industry where they can compete. If the government can provide health insurance better and cheaper, then why do we need private insurers?



Dean Baker is the Co-director of the Center for Economic and Policy Research. CEPR's Jobs Byte is published each month upon release of the Bureau of Labor Statistics' employment report.
Comments

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Thank you, Dean Baker for
Mon, 03/09/2009 - 16:56 — ludlow (not verified)
Thank you, Dean Baker for making the solution be so clear. Private insurers have been ripping us off for years and all we have to show for it is inferior health statistics--we don't live as long or as healthily; we have higher infant mortality and higher maternal death rates than other industrialized nations. The time of the private insurance company is done. We the People need Medicare for all to protect our Life, Liberty and Pursuit of Happiness---in other words to protect our wellness. .
Our current "sickenss care
Mon, 03/09/2009 - 16:46 — Anonymous (not verified)
Our current "sickenss care system" system is the same as Katrina only a bit more subtle....The US does NOT care about it's people, This is USA, Inc....the govt run by corporations witht the only goal being profit. This seems a contradiction to health care. THe media & gov't have billed socialized medicine as communism to make us afraid of it. Our schools, police, firefighters & socail security ARE socialized. We rank #39 in the world (according to WHO) for mecical care....right below Costa Rica. It is shamefull that we are (still at the moment) the richest country in the world yet we walk away from our citizens. I am ready to leave the country! What ever happened to "We the People"? Those who are so opposed to socialized medicine...I ask you...have you actually done your research or do you just take your sound bites from the censored/controlled media?
Dean Baker most likely knows
Mon, 03/09/2009 - 16:30 — NYCartist (not verified)
Dean Baker most likely knows that the US public is in favor, by a majority that is not squeaky, of medicare for all, and also single-payer. So, calling it a battle of two ideologies is a bit skewered. Recently, it was pointed out by FAIR that in the discussions of health care reform on major media, there were only a few who spoke about single-payer, or medicare for all contrasted with at least ten times more advocating keeping private insurers. The Congress is heavily lopsided and titled toward money sources/campaign funding, which are: surprise! insurance industry and big pharma. I look forward to when primary races will give us candidates to elect who reflect what the public wants in re single-payer or medicare for all. It's cheaper to have single-payer. Reframe the argument, if you need to Dean Baker, et al. And add that campaign finance reform is needed. Which will come first? Single-payer health care or public financed elections?
All the premises of our
Mon, 03/09/2009 - 16:23 — freelyb (not verified)
All the premises of our current system are wrong, wrong, wrong. We MUST keep fighting to take our power back from corporate interests on all fronts. Every damn one of them.
This article is right on!
Mon, 03/09/2009 - 16:18 — Svejk (not verified)
This article is right on! We don't need the for-profit insurance companies, and the plans now on the table are little more than bailouts of insurance companies, also in trouble due to the shrinking economy. In the long run, it might be harder for President Obama to pass the restrictions and regulations necessary to allow the insurers to continue than to simply convert to a single-payer system, like H.R. 676. The news blackout on single-payer and the fact that they had to force their way into the health care forum (the intention was to exclude single-payer from all consideration) are another sign that they are frightening the profit-oriented industry.
Baker's article misses the
Mon, 03/09/2009 - 16:17 — We're not as sick as we think (not verified)
Baker's article misses the biggest issue of all, which is the corruption of the medical science itself due to the profound conflicts of interest that pervade the system, especially the FDA and Medical school's relationship to Pharmaceuticals and Hospitals. By example, the U. of Wisconsin study recently showed a 75% drop in breast cancer in women from taking a puny 800 IU of vitamin D, while M.D.'s were taught all these years that Vitamin D is toxic (never learning the difference between D2 and D3). Medicine - socialized or private - would cost 1/4 or less of what it costs now if these conflicts of interest were broken. Example, FDA evaluators vote on licensing drugs from companies they own stock in. The data simply looks different when one conclusion makes you a millionaire. This is the tip of the iceberg.
When in the last fifty years
Mon, 03/09/2009 - 15:44 — bvc (not verified)
MY job went to India two years ago. I'll shed no tears when the insurance hacks, their unethical medical co-conspirators and all the funky middle men who make the American universal illness plan [for that's what it boils down to] so dysfunctional have to do something socially useful with their time. 'Bout time; and then some.
Anyone who has had the
Mon, 03/09/2009 - 15:23 — John Whiing (not verified)
Anyone who has had the experience of being sick in any other developed country (and is not rich) knows that the US system is of benefit only to those who own it.
Mon, 03/09/2009 - 14:57 — radline9 (not verified)
Bankrupt because of medical bills shows the system is corrupt. Even people with insurance are going bankrupt because of medical bills. If you have open heart surgery at a cost of $100,000, many people with insurance end up having to pay $25,000 for the deductable. If you have insurance, it may lead to you having open heart surgery even if you don't need it because they profit even if only the 75,000 is paid. I know someone this happened to. Thank you, Dean Baker, for this great article.
Mon, 03/09/2009 - 14:31 — Anonymous (not verified)
I've always said that the goal of an insurance company is to NOT pay claims. The motivation of a private insurance company is not aligned with the interests of medical consumers. Why have such an organization in between yourself and medical care?
Mon, 03/09/2009 - 14:26 — Uppity Woman (not verified)
We don't need private health insurance companies! We don't need to make a profit off of the suffering and misery of others. It is wrong, it is immoral, and anyone that advocates for-profit health care of any sort is advocating an immoral position. We have known this for centuries, and have the great not for profit health care institutions as the foundation of our modern medical system. We do not need to bring back the leaches to medicine, and that is exactly what happened when we let for-profit medical care and insurance get a foot in the door of our health care system.
Mon, 03/09/2009 - 13:43 — Anonymous (not verified)
I think the people to the right of center are more concerned that the government not redistribute their wealth. Unfortunately, the government, through lack of sound business practices, (retention of non-productive employees, deferred maintenance, lack of commitment to fiscal responsibilities and reality, misdirection and inflexibility) may well consume an equal amount of resources to those returned to stockholders/owners and to the pockets of the management. Insurance is not a good mechanism for health care delivery - it is a business - which is designed to MAKE MONEY for the owners/stockholders. Fundamental to the insurance mechanism is the principle that the insured cannot be made better than he/she was prior to the loss - not exactly a part of the Hippocratic Oath.
Mon, 03/09/2009 - 13:26 — L.D. Freitas (not verified)
We don't need the blood/money sucking private health insurers! Last time I checked, there's nothing in the Constitution that says they have a right to exist!

[Doc]

“I can explain our proposal in 10 seconds,” Dr. Clairmont said. “It will cost 4.5 percent in taxes and there will be no premiums, no pre-existing condition restriction and no tying health care to employment. Because we eliminate health insurance companies, we can save $360 billion a year in administrative costs. Why are our premiums paying for the bonuses of health insurance industry executives?”