Health

Tuesday, September 15, 2009

�� : Information Clearing House - ICH

Sick and Wrong : Information Clearing House - ICH

By Matt Taibbi

Watch Matt Taibbi break down his report on the sad state of health care reform in his blog, Taibblog.

September 14, 2009 "Rolling Stone" September 03, 2009 --- Let's start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It's become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn't be equal to dreaming it up on purpose.

The system doesn't work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it's a miserable failure: Greedy insurance bosses who spent a generation denying preventive care to patients now see their profits sapped by millions of customers who enter the system only when they're sick with incurably expensive illnesses.

The cost of all of this to society, in illness and death and lost productivity and a soaring federal deficit and plain old anxiety and anger, is incalculable — and that's the good news. The bad news is our failed health care system won't get fixed, because it exists entirely within the confines of yet another failed system: the political entity known as the United States of America.

Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers. ....

Monday, September 14, 2009

Majority Of Doctors Back Public Option: New England Journal Of Medicine Study

A new study finds that a majority of physicians support the creation of a public health care option.

A Robert Wood Johnson Foundation (RWJF) study published in Monday's New England Journal of Medicine shows that 63 percent of physicians support a health reform proposal that includes both a public option and traditional private insurance. If the additional 10 percent of doctors who support an entirely public health system are included, then approximately three out of four physicians nationwide support inclusion of a public option. Only 27 percent support a private-only reform that would provide subsidies for low-income individuals to purchase private insurance.

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"We found that no matter how you sliced the data, physicians demonstrated majority support for a public health insurance option, regardless of their type of practice or where they live," said Keyhani.

Among those physicians who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options. The AMA has opposed a public option, saying that it "threatens to restrict patient choice by driving out private insurers."

A majority of physicians surveyed (58 percent) also supported expanding Medicare eligibility to those between the ages of 55 and 64.

"These results give voice to individual physicians in the national discussion about health reform," said Federman. "Most often we hear the opinions of special interest groups rather than doctors themselves, but we know that Americans want to hear the opinions of doctors like those who treat them. This study lets us hear the unfiltered views of physicians on key elements of health reform and should be useful for lawmakers."

Health Insurance Company CEOs Total Compensation in 2008 : HEALTH REFORM WATCH

Health Insurance Company CEOs Total Compensation in 2008 : HEALTH REFORM WATCH
...

Ins. Co. & CEO With 2007 Total CEO Compensation

Aetna Ronald A. Williams: $23,045,834
Cigna H. Edward Hanway: $25,839,777
Coventry Dale B. Wolf : $14,869,823
Health Net Jay M. Gellert: $3,686,230
Humana Michael McCallister: $10,312,557
U.Health Grp Stephen J. Hemsley: $13,164,529
WellPoint Angela Braly (2007): $9,094,271
L. Glasscock (2006): $23,886,169

Ins. Co. & CEO With 2008 Total CEO Compensation

Aetna, Ronald A. Williams: $24,300,112
Cigna, H. Edward Hanway: $12,236,740
Coventry, Dale Wolf: $9,047,469
Health Net, Jay Gellert: $4,425,355
Humana, Michael McCallister: $4,764,309
U. Health Group, Stephen J. Hemsley: $3,241,042
Wellpoint, Angela Braly: $9,844,212

Sunday, September 13, 2009

Internal Memo Confirms Big Giveaways In White House Deal With Big Pharma

Internal Memo Confirms Big Giveaways In White House Deal With Big Pharma

A memo obtained by the Huffington Post confirms that the White House and the pharmaceutical lobby secretly agreed to precisely the sort of wide-ranging deal that both parties have been denying over the past week.
...

It says the White House agreed to oppose any congressional efforts to use the government's leverage to bargain for lower drug prices or import drugs from Canada -- and also agreed not to pursue Medicare rebates or shift some drugs from Medicare Part B to Medicare Part D, which would cost Big Pharma billions in reduced reimbursements.

In exchange, the Pharmaceutical Researchers and Manufacturers Association (PhRMA) agreed to cut $80 billion in projected costs to taxpayers and senior citizens over ten years. Or, as the memo says: "Commitment of up to $80 billion, but not more than $80 billion." ....

Raw Story � Billionaires for WealthCare mocks healthcare protesters in California

Raw Story � Billionaires for WealthCare mocks healthcare protesters in California

“If God loved the poor people, he wouldn’t let them get sick.”

“Healthcare rationing, that’s our job!”

“We love BlueDogs. A solid investment in healthcare profiteering.”

Carrying signs with irreverent messages praising the status quo of the American healthcare system, a farcical anti-healthcare reform group, Billionaires for Wealthcare, paraded outside a Democratic town hall meeting in Spring Valley, California Sunday.

Dressed in business suits and cocktail dresses, and occasionally sporting champagne, the motley crew of “billionaires” cheered on anti-healthcare protesters. They carried signs with messages including “Survival of the RICHEST!” “IT’S A CLASS WAR AND WE’RE WINNING” and “Keep WEALTHCARE alive / NO on HealthCare reform.”

The cavalcade descended on protesters on both side of President Barack Obama’s healthcare proposals outside a townhall event for Rep. Susan Davis (D-CA). They mocked those in opposition to healthcare reform, positing that their opposition was a boon for the private insurance industry — and for the superrich in general.

In a YouTube video the group posted, one top-hatted “billionaire” is quoted as endorsing the privatization of other public services, as well.

“Along with privatized police, [we should have a] privatized fire department,” the gentleman quips. “I mean, because if my cat’s stuck in a tree, I don’t want the fire department taking ten extra minutes because of a silly fire going on somewhere else in my neighborhood. Because if I have the money, I get the first priority.” ...

Economic Scene - Real Choice? It’s Off-Limits in Health Bills - NYTimes.com

Economic Scene - Real Choice? It’s Off-Limits in Health Bills - NYTimes.com

Consider the following health insurance plan.

It refuses to pay for certain medical care and then doesn’t offer a clear explanation. It does pay for unhelpful care that ends up raising premiums. Its customer service can be hard to reach or unhelpful. And the people who are covered by this insurer have no choice but to remain with it — or, at best, to choose from one or two other insurers that are about as bad.

In all likelihood, I have just described your insurance plan.

Health insurers often act like monopolies — like a cable company or the Department of Motor Vehicles — because they resemble monopolies. ...

Employer-Provided Health Care Costs Expected To Rise 10.5% In Next 12 Months

INDIANAPOLIS — Costs for employer-provided health plans are expected to rise more than 10 percent within the next 12 months, a jump workers may feel in their paychecks or through changes to their insurance coverage.

An aging population, rising costs and growing patient demand for services are among the reasons for the higher costs cited in an Aon Consulting report released Tuesday. ...

Dying for affordable healthcare — the uninsured speak | Society | The Guardian

Dying for affordable healthcare — the uninsured speak | Society | The Guardian
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For 35 years Manley had a thriving health clinic in Kansas. He lived in the most affluent neighbourhood of Kansas City and treated himself to a new Porsche every year. But this is not a story about doctors' remuneration and their lavish lifestyles.

In the late 1980s he began to have trouble with his own health. He had involuntary muscle movements and difficulty swallowing. Fellow doctors failed to diagnose him, some guessing wrongly that he had post-traumatic stress from having served in the airforce in Vietnam.

Eventually his lack of motor control interfered with his work to the degree that he was forced to give up his practice. He fell instantly into a catch 22 that he had earlier seen entrap many of his own patients: no work, no health insurance, no treatment.

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn't afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines. In 2000 Manley finally found the help he needed, at a clinic in Kansas City that acts as a rare safety net for uninsured people. He was swiftly diagnosed with Huntington's disease, a degenerative genetic illness, and now receives regular medical attention through the clinic.

So how does he feel about the way the debate in the US has come to be dominated by Republican-inspired attacks on Britain's NHS and other "socialised" health services which give people the treatment they need even if they cannot afford to pay for it?

"I find that repulsive and an absolutely bone-headed way to go," he says. "When I started out practising I certainly didn't expect this would happen. I thought the system would take care of everybody." ...

States With Most Uninsured Most Likely To Believe Euthanasia, Govt. Takeover Myths

The states that have been most skeptical of President Barack Obama's agenda for health care reform also have some of the highest levels of uninsured people in the nation.

A new study by Gallup shows that large swaths of populations in the South and West -- anywhere from one-in-five to one-in-four individuals -- are currently lacking health insurance coverage.

These same regions also have the largest percentage of populations who believe widely perpetuated mistruths about the Obama agenda, including allegations that the president will set up "death panels" and wants a complete government takeover of the health care system.

According to Gallup, of the 25 states with the greatest percentage of the uninsured, all but three are based in the South or the Midwest. ...

Think Progress � Fox News viewers overwhelmingly misinformed about health care reform proposals.

Think Progress � Fox News viewers overwhelmingly misinformed about health care reform proposals.
...
MSNBC’s First Read notes that self-identified viewers of Fox News are disproportionately misinformed:

Here’s another way to look at the misinformation: In our poll, 72% of self-identified FOX News viewers believe the health-care plan will give coverage to illegal immigrants, 79% of them say it will lead to a government takeover, 69% think that it will use taxpayer dollars to pay for abortions, and 75% believe that it will allow the government to make decisions about when to stop providing care for the elderly. But it would be incorrect to suggest that this is ONLY coming from conservative viewers who tune in to FOX. In fact, 41% of CNN/MSNBC viewers believe the misinformation about illegal immigrants, 39% believe the government takeover stuff, 40% believe the abortion misperception, and 30% believe the stuff about pulling the plug on grandma. What’s more, a good chunk of folks who get their news from broadcast TV (NBC, ABC, CBS) believe these things, too. This is about credible messengers using the media to get some of this misinformation out there, not as much about the filter itself. These numbers should worry Democratic operatives, as well as the news media that have been covering this story.

As ThinkProgress has pointed out, Fox News regularly distorts the truth about health care reform. Last week, Media Matters found that over a two day period opponents of health care reform outnumbered supporters by a 6-to-1 margin on Fox.

Debate on health care: Our view -- Dispute over ‘public option’ - Opinion - USATODAY.com

Our view on health care: Dispute over ‘public option’ veers into fantasyland

Here’s a little secret: Government already pays more than insurers.

Depending on who you listen to, a central feature of President Obama's health care overhaul — a government-run insurance plan known as the "public option" — is either dead or on life support. That it is in trouble at all reflects the Alice-in-Wonderland nature of the medical discussion.

In health care politics, down is up, right is left and the sun rises each morning in the West. When lawmakers try to be frugal with taxpayers' money, their actions are labeled as Big Government intruding. When they try to bring some compassion to end-of-life issues, uncontroversial until it was included in a medical proposal, they're accused of promoting euthanasia. And when they ignore the unsustainable amounts of public money pouring into a broken system, they call themselves pro-market.

This last illusion was illustrated in 2003 when Congress, then under Republican control, passed a Medicare drug benefit estimated to cost about $500 billion over a decade. Even though every dime was taxpayers' money, the government was barred from using its clout to negotiate the most advantageous deals with pharmaceutical companies. Borrowing trillions from future generations was OK. Trying to get taxpayers the most for their money was not. ...

Major Health Insurance Company Urges Employees To Attend Tea Parties | TPMDC

At least one major insurer is urging its employees to participate in tea parties.

Last week, UnitedHealth Group--the second largest health insurance company in the country--sent out a letter to its employees urging them to call UHG's United for Health Reform Advocacy Hotline to speak with an advocacy specialist about health care reform. The advocacy specialist, according to the letter, is there to help UHG employees write personalized messages to elected officials, and to arm them with talking points to use at local events in order to better oppose the public health insurance option.

TPM has obtained the letter, which you can read here, but a UHG advocacy specialist was not willing to provide TPM with a copy.

...

Some conservatives have used the fact that industry groups nominally support health care reform to attack liberals and Democrats for blaming town hall disruptions and other public displays of opposition to health care reform on those same groups. Well, as you can see, it's perfectly possible for industry to have it both ways

For Many Consumers, Few Insurance Choices - Prescriptions Blog - NYTimes.com

For Many Consumers, Few Insurance Choices - Prescriptions Blog - NYTimes.com

According to statistics from the American Medical Association, the leading insurance provider in California covers 24 percent of the population, while in New York the figure is 26 percent and in Florida, 30 percent.

But there are nine states where a single insurer covers 70 percent or more of the people. In Hawaii, one insurer covers 78 percent. In Alabama, it’s 83 percent. And in at least 17 other states one insurer covers at least half the population.

Some members of the Senate Finance Committee, which is taking a lead on health care legislation, come from states where the insurance market is highly concentrated. The Democratic chairman, Senator Max Baucus, is from Montana, where 75 percent of people are covered by one major insurer, Blue Cross Blue Shield of Montana. For Senator Charles E. Grassley, Republican of Iowa, the figure is 71 percent, by Wellmark. For Senator Olympia Snowe, Republican of Maine, it’s 78 percent, by WellPoint.

“For many Americans, the idea that they have a choice of health plans is about as mythical as unicorns,” said Jacob Hacker, professor of political science at Yale University.

...

As critics see it, part of the problem is consolidation in the insurance industry. According to the American Medical Association, there have been 400 corporate mergers among insurance providers in the last dozen years. WellPoint alone covers 34.2 million people, according to the company’s second-quarter earnings report. UnitedHealth Group covers 29.5 million, according to its second-quarter statement.

“The largest seven insurers cover more than 100 million people, a third of the market,” said Mr. Potter, who bases his figures on federal securities filings. ...
...

Would non-profit coops provide meaningful competition?

Mr. Potter, the former CIGNA officer, is skeptical.

“Philadelphia, my hometown, is dominated by Independence Blue Cross and Aetna,” he said. As it happens, that’s where CIGNA has its headquarters. “But CIGNA has a small presence there,” he said. “The market is largely locked up by the dominant companies.” ...

Dr. Andrew Weil: What's Wrong With American Medicine?

Dr. Andrew Weil: What's Wrong With American Medicine?

I discuss each in detail, and propose solutions, in my next book, Why Our Health Matters: A Vision of Medicine that can Transform Our Future, which will be published September 8th, 2009.

Trend #1: Deterioration of Medical Philosophy and Practice
Technology has a shadow side. It accounts for real progress in medicine, but has also hurt it in many ways, making it more impersonal, expensive and dangerous. The false belief that a safety net of sophisticated drugs and machines stretches below us, permitting risky or lazy lifestyle choices, has undermined our spirit of self-reliance. The cold fact is that while Americans live more than 30 years longer than they did at the turn of the last century, public health measures such as better sanitation, immunizations, better food and water, and safer and less polluted workplaces account for 25 years of that increase; medical intervention, only five years. A recent study showed that in the 1990s, only about one in 16,000 Americans had his or her life saved or significantly extended by improvements in health-care technology. "Let's Take the Stomachache Out of Health Care Reform" provides a real-world example of a different approach.

Trend #2: Failure to Provide Health Care for All
Virtually every other developed country has a national health care program. They are not perfect and never will be, but they generally work better than ours. Studies in places such as Germany, France, Scandinavia, the United Kingdom and Canada show that citizens in those countries are happier with their systems than we are, and are healthier as well, with lower rates of obesity and chronic disease. I fully support a national health care program for the U.S.

Trend #3: The Growing Influence of Money
This is the darkest cloud over American medicine. The profit motive, once only a part of health care, now drives the whole system. If current trends hold, a family of four will spend about $64,000 annually for health care in the next seven to nine years (except that they obviously can't and won't - so the system, without reform, will collapse before then). ...

Op-Ed Columnist - The Swiss Menace - NYTimes.com

Op-Ed Columnist - The Swiss Menace - NYTimes.com
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Besides being vile and stupid, however, the editorial was beside the point. Investor’s Business Daily would like you to believe that Obamacare would turn America into Britain — or, rather, a dystopian fantasy version of Britain. The screamers on talk radio and Fox News would have you believe that the plan is to turn America into the Soviet Union. But the truth is that the plans on the table would, roughly speaking, turn America into Switzerland — which may be occupied by lederhosen-wearing holey-cheese eaters, but wasn’t a socialist hellhole the last time I looked.

Let’s talk about health care around the advanced world.

Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.

In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.

The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That’s how Canada and, in a more complex fashion, France do it. It’s also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.

Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program. ...

Fareed Zakaria - When Only a Crisis Brings Reforms - washingtonpost.com

Fareed Zakaria - When Only a Crisis Brings Reforms - washingtonpost.com
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Now, to see the weakness of the American system, consider the past two weeks and the debacle of the health-care debate. Clearly the U.S. health-care system is on an unsustainable path. If current trends continue -- and there is no indication that they won't -- health care will consume 40 percent of the national economy by 2050. The problem is that this is a slow and steady decline, producing no crisis. As a result, we seem incapable of grappling with it seriously.

It's not as if the problems aren't apparent to everyone, whatever your political persuasion. Costs are rising so fast that every day more than 10,000 Americans lose their insurance coverage. In 1993, 61 percent of small businesses provided health insurance for their employees. Now only 38 percent do. Larger firms face greater health-care costs. Yet, Americans do worse on almost every health measure than most advanced industrial countries, which spend about half as much on health care per person and have proportionately more elderly people.

Meanwhile, the political debate is unreal, with conservatives suggesting that President Obama is endorsing euthanasia and murder boards, and turning America into Russia. (I guess they haven't noticed that Russia isn't communist anymore.) The lack of serious discussion is tragic, because the Democrats' proposals leave much to be desired. They include only a few, vague measures to rein in costs ...

Raw Story � In MI., Blue Cross raising individual, group rates 22 pct.

Raw Story � In MI., Blue Cross raising individual, group rates 22 pct.

Michigan insurance regulators have approved a 22 percent increase for group and individual Blue Cross Blue Shield health policies in the state, according to reports published Thursday.

“Blue Cross officials have said they need rate increases to help cover $133 million in financial losses in 2008 on its individual health insurance policies,” reported Crain’s Detroit Business.

Blue Cross originally sought to raise individual rates by 56 percent and group rates by 41 percent. Its proposed rate increases were initially rejected by the state’s Office of Financial and Insurance Regulation, which negotiated the still-significant hikes.

The new rates, set to take effect October 1, will affect 163,000 policies.

Blue Cross is also awaiting a September 14 hearing on its proposed 33 percent rate hike for senior citizens, according to Detroit Free Press. ...

Coverage Denied: How the Current Health Insurance System Leaves Millions Behind

A large proportion of Americans have health conditions that insurance companies can qualify as “pre-existing conditions.”

A pre-existing condition is a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease – which affects one in three adults¹ – or something as life-changing as cancer, which affects 11 million Americans.²

But a pre-existing condition does not have to be a serious disease like cancer or heart disease. Even relatively minor conditions like hay fever, asthma, or previous sports injuries can trigger high premiums or denials of coverage.³

^...

A recent national survey estimated that 12.6 million non-elderly adults⁵ – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years.⁶

In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease.⁷

It is still legal in nine states for insurers to reject applicants who are survivors of domestic violence, citing the history of domestic violence as a pre-existing condition.⁸

Even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage.⁹

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Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition.¹⁰

A recent Congressional investigation into this practice found nearly 20,000 rescissions from three large insurers over five years, saving them $300 million in medical claims¹¹ – $300 million that instead had to come out of the pockets of people who thought they were insured, or became bad debt for health care providers.

At least one insurance company has been found to evaluate employee performance based in part on the amount of money an employee saved the company through rescissions.¹² Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage.

Stephen Hawking Enters U.S. Health Care Debate

In an editorial on July 31, Investor's Business Daily warned of end-of-life counseling in health care reform by saying people like Stephen Hawking "wouldn't have a chance" in the such a system.

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

In fact, Professor Hawking lives in England, where he has been treated by their National Health Service. And by his own account, it saved his life.

"I wouldn't be here today if it were not for the NHS," he told The Guardian. "I have received a large amount of high-quality treatment without which I would not have survived."

The Hawking reference in the IBD editorial has since been removed, with this correction added: "This version corrects the original editorial which implied that physicist Stephen Hawking, a professor at the University of Cambridge, did not live in the UK." They don't acknowledge that the NHS has kept Hawking alive there. ...

Deaths from avoidable medical error more than double in past decade, investigation shows: Scientific American Blog

Deaths from avoidable medical error more than double in past decade, investigation shows: Scientific American Blog

Preventable medical mistakes and infections are responsible for about 200,000 deaths in the U.S. each year, according to an investigation by the Hearst media corporation. The report comes 10 years after the Institute of Medicine's "To Err Is Human" analysis, which found that 44,000 to 98,000 people were dying annually due to these errors and called for the medical community and government to cut that number in half by 2004.
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In fact, according to Phil Bronstein, who led the investigation, "The annual medical error death toll is higher than that for fatal car crashes," he said in a prepared statement.

Like Your Health Insurance? Maybe You Shouldn't. - washingtonpost.com

If we fail to reform our health care system this year, a major reason will be that a majority of Americans are satisfied with their health coverage and believe that reform could hurt them. According to a recent (unscientific) Consumer Reports survey, 64 percent of readers are satisfied with their plans -- down from 67 percent in 2007, but still a clear majority. A recent New York Times poll found that 59 percent of Americans do not think that health-care reform will benefit them personally; 69 percent are concerned that reform could harm the quality of their own care and 68 percent are concerned that it could limit their access to treatment.

This is deeply misleading, for two reasons. First, what does it mean to say that you are satisfied with your health insurance? Consider homeowner's insurance. Until you need it -- your house burns down -- you have no way of judging its quality. The same goes for health coverage; until you have a serious illness, the kind where your plan's limits and exclusions may kick in, how do you know if your health coverage is any good?

For one thing, as the House Energy and Commerce Committee uncovered, some insurers go out of their way to revoke coverage for people with serious health problems by looking for mistakes on their original applications. For another, you could be underinsured, like 29 percent of all people with health insurance, according to Consumer Reports. It is politically relevant that two-thirds of Americans seem to like their health coverage, but whether they should like it is another question.

The second problem is that the health coverage that most satisfied Americans have -- employer-based coverage -- is less secure than they think. In America today, we have three main health insurance systems. At one end we have Medicare and the Veterans Health Administration, which (although many anti-reform protesters don't realize it) are government-funded and government-run programs, and generally popular ones. At the other end we have the individual market, in which individuals buy insurance policies directly from health insurers. The individual market is completely broken; according to a recent Commonwealth Fund study, 73 percent of people who tried to buy individual coverage in the last three years did not end up buying a plan. ..

...

If you have a serious illness, like cancer, your expected annual costs could easily be $60,000. The insurer has to charge you at least $60,000 for coverage, or else it will lose money. You can't afford that, so you go without insurance. According to the Commonwealth Fund, 70 percent of people with health problems found it impossible or very difficult to find affordable coverage in the individual market. In short, a "market" for health insurance works only if you prevent insurers from doing what insurers naturally do -- discriminate among people according to how risky they are.

The employer-based system solves this problem. Employers can spread the cost of health insurance across their workforces, so that all employees are treated equally, regardless of their medical history. Furthermore, the tax rules governing employer-provided health care require that employers offer plans that treat all employees equally. The result is that if your employer provides health coverage, you can probably get it.

... First, and most obviously, it means keeping your health insurance is dependent on keeping your job. ...

... Second, employers are dropping their health plans; the percentage of people covered through an employer has dropped from 64 percent in 2000 to 59 percent in 2007, and that decline is likely to accelerate. ...

Wednesday, September 9, 2009

Sick and Wrong : Rolling Stone

Sick and Wrong : Rolling Stone

Here's where we are right now: Before Congress recessed in August, four of the five committees working to reform health care had produced draft bills. On the House side, bills were developed by the commerce, ways and means, and labor committees. On the Senate side, a bill was completed by the HELP committee (Health, Education, Labor and Pensions, chaired by Ted Kennedy). The only committee that didn't finish a bill is the one that's likely to matter most: the Senate Finance Committee, chaired by the infamous obfuscating dick Max Baucus, a right-leaning Democrat from Montana who has received $2,880,631 in campaign contributions from the health care industry.
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Even worse, Baucus has set things up so that the final Senate bill will be drawn up by six senators from his committee: a gang of three Republicans (Chuck Grassley of Iowa, Olympia Snowe of Maine, Mike Enzi of Wyoming) and three Democrats (Baucus, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico) known by the weirdly Maoist sobriquet "Group of Six." The setup senselessly submarines the committee's Democratic majority, effectively preventing members who advocate a public option, like Jay Rockefeller of West Virginia and Robert Menendez of New Jersey, from seriously influencing the bill. Getting movement on a public option — or any other meaningful reform — will now require the support of one of the three Republicans in the group: Grassley (who has received $2,034,000 from the health sector), Snowe ($756,000) or Enzi ($627,000).

This is what the prospects for real health care reform come down to — whether one of three Republicans from tiny states with no major urban populations decides, out of the goodness of his or her cash-fattened heart, to forsake forever any contributions from the health-insurance industry (and, probably, aid for their re-election efforts from the Republican National Committee). ...

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Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.

... Not one of the 41 witnesses, however, was in favor of single-payer — even though eliminating the insurance companies enjoys broad public support. Leading advocates of single-payer, including doctors from the Physicians for a National Health Program, implored Baucus to allow them to testify. When he refused, a group of eight single-payer activists, including three doctors, stood up during the hearings and asked to be included in the discussion. One of the all-time classic moments in the health care reform movement came when the second protester to stand up, Katie Robbins of Health Care Now, declared, "We need single-payer health care!"

... The concession to the Blue Dogs comes at a potentially disastrous price: Without a public option that drives down prices, the cost of other health care reforms being considered by Congress will almost certainly skyrocket. The trade-off with conservatives might be understandable, if those other reforms were actually useful. But this is Congress we're talking about. ...

Monday, September 7, 2009

As 'Rescissions' Spawn Outrage, Health Insurers Cite Fraud Control - washingtonpost.com

By Karl Vick

Washington Post Staff Writer
Tuesday, September 8, 2009

LOS ANGELES -- The untimely disappearance of Sally Marrari's medical coverage goes a long way toward explaining why insurance companies are cast as the villain in the health-care reform drama.

"They said I never mentioned I had a back problem," said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company's claim that she had committed fraud by not listing on a health questionnaire "preexisting conditions" Marrari said she did not know she had.

By the time she filed a lawsuit in 2008, she also got a diagnosis of pancreatic cancer and her debts had swelled beyond $200,000. She was able to see a specialist by trading office visits for work on the doctor's 1969 Porsche at the garage she owns with her husband.

...

Rescission -- the technical term for canceling coverage on grounds that the company was misled -- is often considered among the most offensive practices in an insurance industry that already suffers from a distinct lack of popularity among the American public. Tales of cancellations have fueled outrage among regulators, analysts, doctors and, not least, plaintiffs' lawyers, who describe insurers as too eager to shed patients to widen profits. ...

...

In the past 18 months, California's five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

"This is probably the most egregious of examples of health insurers using their power and their resources to deny benefits to people who are most in need of care," said Gerald Kominski, associate director of the Center for Health Policy Research at the University of California at Los Angeles. "It's really a horrendous activity on the part of the insurers." ....

HMO claims-rejection rates trigger state investigation -- latimes.com

...

The increased attention also comes on the heels of a first-of-its-kind report issued this week that said the California health insurers reject 1 in 5 medical claims.

Six of the state's largest insurers rejected 45.7 million claims for medical care, or 22% of all claims, from 2002 to June 30, 2009, according to the California Nurses Assn.'s analysis of data submitted to regulators by the companies.

The rejection rates ranged from a high of 39.6% for PacifiCare to 6.5% for Aetna for the first half of 2009. Cigna denied 33%, and Health Net 30%.

Anthem Blue Cross, the state's largest for-profit health plan, and Kaiser, the state's largest nonprofit plan, each rejected 28% of claims.

Blue Shield, a nonprofit with 3.4 million California members, is the only large health plan that does not report claims-denial figures in its annual report to the state Department of Managed Health Care.

State health plans say claims often are denied because they are duplicates, because patients are no longer members, and because a particular treatment is not a covered benefit.

...

PacifiCare, the Cypress-based subsidiary of UnitedHealthcare Group, ranked highest in the state for claims denied in the first half of 2009. It has been the subject of considerable scrutiny for its claims-handling practices.

The HMO paid $3.5 million in fines last year for claims payment problems, and the department is conducting a follow-up examination.

"We still do get frequent complaints about PacifiCare, and obviously the numbers in the California Nurses Assn. report backed that up," Randolph said. "We do expect we will be taking some further action."

PacifiCare also faces a hearing this year over state Department of Insurance allegations of 133,000 violations of claims-handling laws that could result in as much as $1.33 billion in fines. ...

[No matter the rights / wrongs etc., one thing is clear ... the is the most expensive, inaccurate billing payment settlement process imaginable -- no wonder US healthcare has such exorbitant overhard costs. ed.]

Raw Story � McCain campaign-stop factory ceases paying health premiums, tells no one

...

When then-presidential candidate John McCain declared Pennsylvania’s Turbine Airfoil Designs an example of “both the opportunities and the challenges that face our manufacturing base,” he probably had little inkling that one of those “challenges” would be the company’s decision to stop paying the premiums on its employees’ health care — without telling the employees.

Until they received a letter from Capital BlueCross in March of this year informing them that their insurance had been canceled, employees at the aircraft parts manufacturer in Harrisburg, Pennsylvania, thought their insurance policies were valid, because their insurance cards continued to be accepted.

But, in fact, TAD had stopped paying health insurance premiums in October, 2008, even as employees continued to see health premiums deducted from their paychecks.

In the nearly half-year-long intermittent period, some employees racked up health care bills of more than $10,000 — bills that they are now on the hook for themselves, the local CBS affiliate first reported. ...