American Health Care: A Great Way to Die's topics - tribe.net

President Bush to Kansas City Poor: Go Ahead and Die!

2007-01-28T14:07:21Z

.[c]2007 by Richard L Zorek.........01.28.07........
President Bush came to Kansas City on Jan 25 in order to to tell a select group of people at St Luke's Hospital in Lee's Summit, that he doesn't acknowledge the plight of the poor when it comes to health care. Missouri Senator Kit Bond accompanied him. He came to promote what he is calling a "health care proposal," which in reality is nothing more than a tax break for the rich and upper middle class. Bush told the group, "There is no question in my mind that a proper role for the federal government is to help the poor and the elderly and the diseased get health care." But, he never offered any ideas on how they are helping. His proposal isn't helping them. Bush proposed taxing employer-provided health care benefits, after allowing a $7,500 deduction for individuals and $15,000 for families. He said the plan would help individuals buy insurance, while keeping health care costs low. His plan does not help the poor and uninsured who truly need medical care. About half of the uninsured earn so little that they do not file income taxes, so the standard deduction would not help them. One of the "selected" audience member was an uninsured waitress. She was selected to give the impression that his plan really will help the poor. The truth is, though that she may be a waitress, but she has a husband who works also and they do not have a family riddled with health problems. <p>
He told staff as he toured the hospital, “Medicine is finally catching up with the rest of America in the use of information technology, particularly this facility here." It is too bad tha Bush and his administration hasn't caught up with the rest of America. People who don't get health care die. The last thing they say as they are dying is not "I wish I had a tax break."

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A Modest Health Care Proposal

2006-11-21T12:26:02Z

As with any new legislation, the cost of it is always the first....or at least should be....the first to be considered. Granted, health care for everyone could get expensive. But, it is a necessary thing. There are too many people who have "fallen through the cracks" and are sick and or even dying because of lack of health care. So, America needs to set it priorities straight. A new budget needs to be made, with a few cuts and changes.

First, cut the number of Senators from 100 to 25. Every state can share one. North and South Dakota, and North and South Carolina, for example. And those little states in the Northeast may even be able to do with one for three states. That will get a lot of needless weight off the government payroll. Drop the number of representatives down to 50: one for each state. It's not like very many of them actually listen to their districts anyway when it comes to creating budgets and expenses, anyway. That will cut out a whole lot of payroll. Get rid of the Vice President position. It's an honorary position and we really dont need a paid "yes-man" for the president. Cut the Supreme Court down to two: One very liberal and the other very conservative. The president can make coin toss on the split decision. Congress will have to hire out of themselves to have a budget created. It has to be made by some company who doesnt have a vested interest. This, in itself, could save billions and billions of dollars and needless pork barrel projects. The savings on just these few suggestions will be astronomical. The extra money can be put into the new health care system....after an investigation is done to discover by what authority the medical community and pharmaceutical companies have decided to overcharge people for their "costs." Price gougers in that field will be punished severely.....and yes, I mean they will not be allowed to have access to any health care.

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Working People

2006-11-19T07:50:33Z

http://www.workingpeople.org/mainPage/healthcare.htm

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Health: To Be Under the Senates Thumb or Not to be

2006-10-02T05:17:31Z

......[c]2006 by
<i>Richard L Zorek....10.02.06.........
Missouri Senator Jim Talent and challenger Claire McCaskill have similar views on importing prescription drugs, but Talent seems to favor government scrutiny also (which is, in other words, more government intervention on it..which is clearly the problem we have already). He says, "I’ve always supported permitting reimportation through a process that guaranteed safety. Many of these drugs are manufactured in third world countries, and I want to make sure our consumers are protected. I support a provision in the Homeland Security funding bill that would allow U.S. citizens to bring a 90-day supply of prescription drugs for personal use back from Canada." So, every 90 days people have to run back to Canada? McCaskill, on the other hand, gets right to the point: "If Congress is going to remain under the thumb of the pharmaceutical industry, Americans ought to have the choice to import prescription drugs from other countries that haven’t been put under its spell." Apparently, the number of sick people in America without insurance and affordable prescriptions wouldn't be a big deal to Talent as long as Congress, or Homeland security can scrutinize it (which is a nice way of saying "dissecting" or even "destroying" the ideas.

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Wal-mart to cut prices for generic drugs

2006-09-23T00:30:04Z

By ANNE D'INNOCENZIO, AP Business Writer
Fri Sep 22, 7:35 AM ET

NEW YORK - Wal-Mart, the world's largest retailer, plans to slash the prices of almost 300 generic prescription drugs, offering a big lure for bargain-seeking customers and presenting a challenge to competing pharmacy chains and makers of generic drugs.

The drugs will be sold for as little as $4 for a month's supply and include some of the most commonly prescribed medicines such as Metformin, a popular generic drug used to treat diabetes, and the high blood pressure medicine Lisinopril.

Wal-Mart Stores Inc. will launch the program Friday at 65 Wal-Mart, Neighborhood Market and Sams' Club pharmacies in Florida's Tampa Bay area. It will be expanded statewide in January and rolled out to the rest of the nation next year, company officials said Thursday.

The news sent the shares of big pharmacy chains like Walgreen's and CVS slumping because of fears that Wal-Mart's price cuts could cost them market share. Analysts said consumers will save an average of 20 percent and up to 90 percent in some cases. Shares of prescription drug management companies and some generic drugmakers fell as well.

Analysts said the risks to Wal-Mart are slim because profit margins on most of the drugs already are low — and the program could help the Arkansas-based retailer address an image problem stemming from its policies on health insurance coverage for employees.

"They are doing something that may be good for consumers, but they don't have altruistic motives," said Patricia Edwards, a portfolio manager and retail analyst at Wentworth, Hauser & Violich in Seattle. "They are capitalists. They still need to make a profit."

Tampa Wal-Mart pharmacy customer Pat Sullivan, a retired Massachusetts police officer, said $4 generic prescriptions would be a tremendous help.

"I'm on disability and my benefits run out by the end of the month," he said. "It comes down to where do I go for a $100 prescription? I have no outlet other than to break a pill in half and take half today and half tomorrow."

The $4 prescriptions are not available by mail order and are being offered online only if picked up in person in the Tampa Bay area.

Bill Simon, executive vice president of the company's professional services division, told reporters that the generic drugs would not be sold at a loss to entice customers into the stores, a strategy that has been used in Wal-Mart's toy business.

"We're able to do this by using one of our greatest strengths as a company — our business model and our ability to drive costs out of the system, and the model that passes those costs savings to our customers," he said at a Tampa Wal-Mart. "In this case, we're applying that business model to health care."

Simon said Wal-Mart is working with the 30 participating drug companies to help them be more efficient. "We are working with them as partners. We are not pressuring them to reduce prices," he said.

David W. Maris, an analyst at Banc of America, said in a report issued Thursday that the plan could "squeeze the generic manufacturers." But Kathleen Jaeger, president and CEO of the Generic Pharmaceutical Association, disputed that, saying Wal-Mart's plan will have "little impact" on its members.

The initiative follows a series of moves by Wal-Mart to improve its health benefits since last October. They include relaxing eligibility requirements for its part-time employees who want health insurance, and extending coverage for the first time to the children of those employees. Last October, Wal-Mart offered a new lower-premium insurance aimed at getting more of its work force on company plans.

Wal-Mart's shares fell 41 cents to close at $48.46 in trading Thursday on the New York Stock Exchange. But shares of the nation's largest drug chain, Walgreen Co., slumped 7.4 percent and the stock of rivals CVS Corp. and Rite-Aid Corp. dropped more than 8 percent and more than 5 percent, respectively. Shares of generic drug makers Barr Pharmaceuticals Inc.'s and Mylan Labs also fell, as did the stock of Caremark RX Inc., a pharmacy benefit manager firm.

Still, Rite-Aid and Walgreens executives both noted that Wal-Mart's list of the discounted generics contains only a small percent of the 1,500 and 1,800 generic drugs each offers, respectively.

Faced with soaring drug costs, consumers are increasingly turning to generic drugs, which often are made by multiple companies after the original patent on the medicines expire. The average monthly cost for a generic drug prescription is $28.74, according to the National Association of Chain Drug Stores. For branded drugs, that figure is $96.01.

The Generic Pharmaceutical Association, a trade association, said generic medicines account for 56 percent of all prescriptions dispensed in the United States, but only 13 percent of all dollars spent on prescription drugs.

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No Health Insurance? It's Enough to Make You Sick - Scientific Research Linking the Lack of Health Coverage to Poor Health

2006-08-10T03:44:19Z

http://www.acponline.org/uninsured/lack-contents.htm

In the past ten years, several hundred studies have been conducted to document the plight of uninsured Americans. The evidence from these studies contradicts the notion that a lack of insurance is merely an inconvenience as is often supposed by many Americans. These studies confirm that there are real consequences of being uninsured. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM), representing 115,000 physicians of internal medicine and medical students, presents the significant data it has collected in "No Health Insurance? It's Enough to Make You Sick."

The quality of American medicine is world-renowned. The failure to provide access to this care for all Americans is equally well-known. As we enter the new millennium, in a period of record prosperity, a staggering 44 million Americans do not have access to health care and suffer poorer medical outcomes simply because they lack health insurance.

As physicians, our primary mission is to care, to heal, to advocate for the sick, and to promote the good health of the individual and the nation. On a daily basis, we see the delayed treatment and poorer health that results from a lack of insurance. It is consistent with the mission of the College to take on the challenge of documenting the consequences of a lack of insurance.

Uninsured Americans are far less likely to have a regular source of care or to have recently seen a physician. They are more likely to delay seeking care, even when ill or injured, and more likely to report unmet medical needs. They are more likely to forego even those services that many of us take for granted, such as annual exams, well-child care visits, prescriptions drugs, eyeglasses, or dental care.

As a result of this reduced access to care, uninsured Americans are more vulnerable to adverse health outcomes. Because uninsured Americans do not have the same access to care, they are more often hospitalized for conditions, such as diabetes, hypertension, pneumonia, or ulcers, that the insured are able to manage as outpatients through physician care or medications. Uninsured Americans are more often diagnosed with cancer at a later stage and, as a result, suffer a lower survival rate.

Uninsured children are much less likely to receive medical care for normal childhood illnesses, such as a sore throat, an earache, or asthma. They are also less likely to receive recommended childhood immunizations. Even if an uninsured child suffers a serious illness or injury, such as appendicitis or a broken bone, they are often unable to seek medical care.

Evidence from these studies indicates that reduced access to care and poorer medical outcomes do not affect only the chronically uninsured. Even those with gaps in coverage - as short as one month or as long as a year or more - are less likely to seek care, pursue preventive care, or even to have prescriptions filled.

A lack of insurance is not simply an inconvenience. It is a real barrier to access and definitely contributes to poorer health. With 44 million Americans uninsured, and 100,000 more added to their ranks each month, their vulnerability to poorer health has reached epidemic proportions.

Lack of insurance is a public health risk that results in poorer health and earlier death. Ensuring that all Americans have health insurance can reduce the total burden of illness facing the United States. ACP-ASIM calls upon all elected leaders and policy-makers to focus their attention on the documented problems of uninsured Americans to ensure that all Americans benefit from the provision of health insurance.

Whitney W. Addington, MD, FACP
President
American College of Physicians-American Society of Internal Medicine

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Missouri governor signs bill expanding health insurance access

2006-07-15T05:51:28Z

Missouri governor signs bill expanding health insurance access

KANSAS CITY, Mo. -- Gov. Matt Blunt signed legislation Friday aimed at increasing access to affordable health insurance for employees of small businesses.

The bill, sponsored by Rep. Jay Wasson, R-Nixa, expands eligibility for association health plans by decreasing the mandatory number of members from 100 to 50. The Department of Insurance also would be allowed to exempt insurers that cover both small and large businesses from certain rate restrictions.

Blunt said giving small businesses access to affordable health coverage is one way to keep more people out of emergency rooms.

"I believe this will be among the most important legislation we pass this year," he said during a visit to Kansas City, one of several stops around the state to promote the new law.

Friday also marked the last day for the governor to sign bills, and the health insurance measure was his final act on legislation passed this spring. With a Republican-led Legislature sending bills to a Republican governor, Blunt vetoed no bills this year, though he did bar a few spending items in budget bills, mostly for technical reasons. In all, 165 new laws were enacted.

Association or consortium health plans were already available for small businesses under existing law, but this bill allows the establishment of "protective covenants," according to Rep. Doug Ervin, R-Kearney. Instead of bidding for health insurance as 50 individual businesses, the covenants allow a particular association to submit one bid for the whole group, which is then treated as one large company.

Ervin believes the covenants also will help to drive down the cost of health coverage by allowing consortiums to pressure individual members to keep employees healthy. For example, if one company has too many smokers whose health claims are driving up premiums for the entire association, other companies in the consortium can nag the bothersome one to make changes. However, consortiums are not allowed to oust the offending company.

"Peer pressure is a good thing in this case," Ervin said.

There is no cap on the number of employees a company can have to join a consortium. Small businesses with two employees could form associations with companies that employ 200 people. The larger the number of employees in a consortium, the more evenly risk is distributed.

The legislation is modeled after a pilot project that involved the Southwest Area Manufacturers Association's health care consortium. The consortium, with 32 member companies, represents 1,300 employees and covers 2,000 people. The companies were required to sign up for at least 30 months of coverage. Six companies were unable to afford group health care coverage for their employees before joining the consortium, the governor's office said. Initial premium savings ranged from 18 percent for large employers to up to 50 percent for small employers.

Businesses cannot form a new organization strictly to get lower-cost health coverage, said Brent Butler, the Missouri Insurance Coalition's government affairs director. Most already belong to industry associations, such as a chamber of commerce.

"This gives one more option to small business owners when they go out to shop for health insurance benefits for themselves and for their employees," said Kelly Peerson, grass-roots coordinator for the National Federation for Independent Business, which lobbied for the legislation. "If you own a business and you would like to have health insurance for your employees, you're limited in what you can shop for."

___

Health insurance bill is HB1827.

On the Net:

Legislature: http://www.moga.mo.gov

All content © Copyright 2001 - 2006 WorldNow and KCTV5. All Rights Reserved.

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THE MORAL-HAZARD MYTH: The bad idea behind our failed health-care system.

2006-07-14T02:49:13Z

by MALCOLM GLADWELL

Tooth decay begins, typically, when debris becomes trapped between the teeth and along the ridges and in the grooves of the molars. The food rots. It becomes colonized with bacteria. The bacteria feeds off sugars in the mouth and forms an acid that begins to eat away at the enamel of the teeth. Slowly, the bacteria works its way through to the dentin, the inner structure, and from there the cavity begins to blossom three-dimensionally, spreading inward and sideways. When the decay reaches the pulp tissue, the blood vessels, and the nerves that serve the tooth, the pain starts—an insistent throbbing. The tooth turns brown. It begins to lose its hard structure, to the point where a dentist can reach into a cavity with a hand instrument and scoop out the decay. At the base of the tooth, the bacteria mineralizes into tartar, which begins to irritate the gums. They become puffy and bright red and start to recede, leaving more and more of the tooth’s root exposed. When the infection works its way down to the bone, the structure holding the tooth in begins to collapse altogether.

Several years ago, two Harvard researchers, Susan Starr Sered and Rushika Fernandopulle, set out to interview people without health-care coverage for a book they were writing, “Uninsured in America.” They talked to as many kinds of people as they could find, collecting stories of untreated depression and struggling single mothers and chronically injured laborers—and the most common complaint they heard was about teeth. Gina, a hairdresser in Idaho, whose husband worked as a freight manager at a chain store, had “a peculiar mannerism of keeping her mouth closed even when speaking.” It turned out that she hadn’t been able to afford dental care for three years, and one of her front teeth was rotting. Daniel, a construction worker, pulled out his bad teeth with pliers. Then, there was Loretta, who worked nights at a university research center in Mississippi, and was missing most of her teeth. “They’ll break off after a while, and then you just grab a hold of them, and they work their way out,” she explained to Sered and Fernandopulle. “It hurts so bad, because the tooth aches. Then it’s a relief just to get it out of there. The hole closes up itself anyway. So it’s so much better.”

People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you’re not going to get a job as a receptionist, say, or a cashier. You’re going to be put in the back somewhere, far from the public eye. What Loretta, Gina, and Daniel understand, the two authors tell us, is that bad teeth have come to be seen as a marker of “poor parenting, low educational achievement and slow or faulty intellectual development.” They are an outward marker of caste. “Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”

The U. S. health-care system, according to “Uninsured in America,” has created a group of people who increasingly look different from others and suffer in ways that others do not. The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insur-ance. Because the uninsured are sicker than the rest of us, they can’t get better jobs, and because they can’t get better jobs they can’t afford health insurance, and because they can’t afford health insurance they get even sicker. John, the manager of a bar in Idaho, tells Sered and Fernandopulle that as a result of various workplace injuries over the years he takes eight ibuprofen, waits two hours, then takes eight more—and tries to cadge as much prescription pain medication as he can from friends. “There are times when I should’ve gone to the doctor, but I couldn’t afford to go because I don’t have insurance,” he says. “Like when my back messed up, I should’ve gone. If I had insurance, I would’ve went, because I know I could get treatment, but when you can’t afford it you don’t go. Because the harder the hole you get into in terms of bills, then you’ll never get out. So you just say, ‘I can deal with the pain.’ ”

One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century—during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years—efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected. Instead, the United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.

America’s health-care mess is, in part, simply an accident of history. The fact that there have been six attempts at universal health coverage in the last century suggests that there has long been support for the idea. But politics has always got in the way. In both Europe and the United States, for example, the push for health insurance was led, in large part, by organized labor. But in Europe the unions worked through the political system, fighting for coverage for all citizens. From the start, health insurance in Europe was public and universal, and that created powerful political support for any attempt to expand benefits. In the United States, by contrast, the unions worked through the collective-bargaining system and, as a result, could win health benefits only for their own members. Health insurance here has always been private and selective, and every attempt to expand benefits has resulted in a paralyzing political battle over who would be added to insurance rolls and who ought to pay for those additions.

Policy is driven by more than politics, however. It is equally driven by ideas, and in the past few decades a particular idea has taken hold among prominent American economists which has also been a powerful impediment to the expansion of health insurance. The idea is known as “moral hazard.” Health economists in other Western nations do not share this obsession. Nor do most Americans. But moral hazard has profoundly shaped the way think tanks formulate policy and the way experts argue and the way health insurers structure their plans and the way legislation and regulations have been written. The health-care mess isn’t merely the unintentional result of political dysfunction, in other words. It is also the deliberate consequence of the way in which American policymakers have come to think about insurance.

“Moral hazard” is the term economists use to describe the fact that insurance can change the behavior of the person being insured. If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you’ll drink more Pepsi than you would have otherwise. If you have a no-deductible fire-insurance policy, you may be a little less diligent in clearing the brush away from your house. The savings-and-loan crisis of the nineteen-eighties was created, in large part, by the fact that the federal government insured savings deposits of up to a hundred thousand dollars, and so the newly deregulated S. & L.s made far riskier investments than they would have otherwise. Insurance can have the paradoxical effect of producing risky and wasteful behavior. Economists spend a great deal of time thinking about such moral hazard for good reason. Insurance is an attempt to make human life safer and more secure. But, if those efforts can backfire and produce riskier behavior, providing insurance becomes a much more complicated and problematic endeavor.

In 1968, the economist Mark Pauly argued that moral hazard played an enormous role in medicine, and, as John Nyman writes in his book “The Theory of the Demand for Health Insurance,” Pauly’s paper has become the “single most influential article in the health economics literature.” Nyman, an economist at the University of Minnesota, says that the fear of moral hazard lies behind the thicket of co-payments and deductibles and utilization reviews which characterizes the American health-insurance system. Fear of moral hazard, Nyman writes, also explains “the general lack of enthusiasm by U.S. health economists for the expansion of health insurance coverage (for example, national health insurance or expanded Medicare benefits) in the U.S.”

What Nyman is saying is that when your insurance company requires that you make a twenty-dollar co-payment for a visit to the doctor, or when your plan includes an annual five-hundred-dollar or thousand-dollar deductible, it’s not simply an attempt to get you to pick up a larger share of your health costs. It is an attempt to make your use of the health-care system more efficient. Making you responsible for a share of the costs, the argument runs, will reduce moral hazard: you’ll no longer grab one of those free Pepsis when you aren’t really thirsty. That’s also why Nyman says that the notion of moral hazard is behind the “lack of enthusiasm” for expansion of health insurance. If you think of insurance as producing wasteful consumption of medical services, then the fact that there are forty-five million Americans without health insurance is no longer an immediate cause for alarm. After all, it’s not as if the uninsured never go to the doctor. They spend, on average, $934 a year on medical care. A moral-hazard theorist would say that they go to the doctor when they really have to. Those of us with private insurance, by contrast, consume $2,347 worth of health care a year. If a lot of that extra $1,413 is waste, then maybe the uninsured person is the truly efficient consumer of health care.

The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”

For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.

Sered and Fernandopulle tell the story of Steve, a factory worker from northern Idaho, with a “grotesquelooking left hand—what looks like a bone sticks out the side.” When he was younger, he broke his hand. “The doctor wanted to operate on it,” he recalls. “And because I didn’t have insurance, well, I was like ‘I ain’t gonna have it operated on.’ The doctor said, ‘Well, I can wrap it for you with an Ace bandage.’ I said, ‘Ahh, let’s do that, then.’ ” Steve uses less health care than he would if he had insurance, but that’s not because he has defeated the scourge of moral hazard. It’s because instead of getting a broken bone fixed he put a bandage on it.

At the center of the Bush Administration’s plan to address the health-insurance mess are Health Savings Accounts, and Health Savings Accounts are exactly what you would come up with if you were concerned, above all else, with minimizing moral hazard. The logic behind them was laid out in the 2004 Economic Report of the President. Americans, the report argues, have too much health insurance: typical plans cover things that they shouldn’t, creating the problem of overconsumption. Several paragraphs are then devoted to explaining the theory of moral hazard. The report turns to the subject of the uninsured, concluding that they fall into several groups. Some are foreigners who may be covered by their countries of origin. Some are people who could be covered by Medicaid but aren’t or aren’t admitting that they are. Finally, a large number “remain uninsured as a matter of choice.” The report continues, “Researchers believe that as many as one-quarter of those without health insurance had coverage available through an employer but declined the coverage. . . . Still others may remain uninsured because they are young and healthy and do not see the need for insurance.” In other words, those with health insurance are overinsured and their behavior is distorted by moral hazard. Those without health insurance use their own money to make decisions about insurance based on an assessment of their needs. The insured are wasteful. The uninsured are prudent. So what’s the solution? Make the insured a little bit more like the uninsured.

Under the Health Savings Accounts system, consumers are asked to pay for routine health care with their own money—several thousand dollars of which can be put into a tax-free account. To handle their catastrophic expenses, they then purchase a basic health-insurance package with, say, a thousand-dollar annual deductible. As President Bush explained recently, “Health Savings Accounts all aim at empowering people to make decisions for themselves, owning their own health-care plan, and at the same time bringing some demand control into the cost of health care.”

The country described in the President’s report is a very different place from the country described in “Uninsured in America.” Sered and Fernandopulle look at the billions we spend on medical care and wonder why Americans have so little insurance. The President’s report considers the same situation and worries that we have too much. Sered and Fernandopulle see the lack of insurance as a problem of poverty; a third of the uninsured, after all, have incomes below the federal poverty line. In the section on the uninsured in the President’s report, the word “poverty” is never used. In the Administration’s view, people are offered insurance but “decline the coverage” as “a matter of choice.” The uninsured in Sered and Fernandopulle’s book decline coverage, but only because they can’t afford it. Gina, for instance, works for a beauty salon that offers her a bare-bones health-insurance plan with a thousand-dollar deductible for two hundred dollars a month. What’s her total income? Nine hundred dollars a month. She could “choose” to accept health insurance, but only if she chose to stop buying food or paying the rent.

The biggest difference between the two accounts, though, has to do with how each views the function of insurance. Gina, Steve, and Loretta are ill, and need insurance to cover the costs of getting better. In their eyes, insurance is meant to help equalize financial risk between the healthy and the sick. In the insurance business, this model of coverage is known as “social insurance,” and historically it was the way health coverage was conceived. If you were sixty and had heart disease and diabetes, you didn’t pay substantially more for coverage than a perfectly healthy twenty-five-year-old. Under social insurance, the twenty-five-year-old agrees to pay thousands of dollars in premiums even though he didn’t go to the doctor at all in the previous year, because he wants to make sure that someone else will subsidize his health care if he ever comes down with heart disease or diabetes. Canada and Germany and Japan and all the other industrialized nations with universal health care follow the social-insurance model. Medicare, too, is based on the social-insurance model, and, when Americans with Medicare report themselves to be happier with virtually every aspect of their insurance coverage than people with private insurance (as they do, repeatedly and overwhelmingly), they are referring to the social aspect of their insurance. They aren’t getting better care. But they are getting something just as valuable: the security of being insulated against the financial shock of serious illness.

There is another way to organize insurance, however, and that is to make it actuarial. Car insurance, for instance, is actuarial. How much you pay is in large part a function of your individual situation and history: someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan. In recent years, the private insurance industry in the United States has been moving toward the actuarial model, with profound consequences. The triumph of the actuarial model over the social-insurance model is the reason that companies unlucky enough to employ older, high-cost employees—like United Airlines—have run into such financial difficulty. It’s the reason that automakers are increasingly moving their operations to Canada. It’s the reason that small businesses that have one or two employees with serious illnesses suddenly face unmanageably high health-insurance premiums, and it’s the reason that, in many states, people suffering from a potentially high-cost medical condition can’t get anyone to insure them at all.

Health Savings Accounts represent the final, irrevocable step in the actuarial direction. If you are preoccupied with moral hazard, then you want people to pay for care with their own money, and, when you do that, the sick inevitably end up paying more than the healthy. And when you make people choose an insurance plan that fits their individual needs, those with significant medical problems will choose expensive health plans that cover lots of things, while those with few health problems will choose cheaper, bare-bones plans. The more expensive the comprehensive plans become, and the less expensive the bare-bones plans become, the more the very sick will cluster together at one end of the insurance spectrum, and the more the well will cluster together at the low-cost end. The days when the healthy twenty-five-year-old subsidizes the sixty-year-old with heart disease or diabetes are coming to an end. “The main effect of putting more of it on the consumer is to reduce the social redistributive element of insurance,” the Stanford economist Victor Fuchs says. Health Savings Accounts are not a variant of universal health care. In their governing assumptions, they are the antithesis of universal health care.

The issue about what to do with the health-care system is sometimes presented as a technical argument about the merits of one kind of coverage over another or as an ideological argument about socialized versus private medicine. It is, instead, about a few very simple questions. Do you think that this kind of redistribution of risk is a good idea? Do you think that people whose genes predispose them to depression or cancer, or whose poverty complicates asthma or diabetes, or who get hit by a drunk driver, or who have to keep their mouths closed because their teeth are rotting ought to bear a greater share of the costs of their health care than those of us who are lucky enough to escape such misfortunes? In the rest of the industrialized world, it is assumed that the more equally and widely the burdens of illness are shared, the better off the population as a whole is likely to be. The reason the United States has forty-five million people without coverage is that its health-care policy is in the hands of people who disagree, and who regard health insurance not as the solution but as the problem.

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If I Were an Apple, I Would Have Arlen Specter's Attention

2006-07-10T02:40:48Z

.......[c]2006 byRichard L Zorek......7.09.06...........
On April 15th, 2003, Sen Arlen Specter (R-PA), a senior member of the Appropriations Committee on Agriculture, Joined 24 of his fellow senators in a bipartisan letter to the Dept of Agriculture, urging the department to improve the crop insurance policy for apples throughout the country. These improvements include options to upgrade coverage from the cider grade and would provide adequate coverage against unpredictable weather and volatile markets
What Sen Arlen Spector did not do that year was ask for any insurance policies, coverages or issues relating to insuring the people of the United States. They signed off the letter by saying "We thank you for your timely attention to the concerns of apple farmers across the country regarding their crop insurance needs." If I were an apple, or an apple farmer, I guess I might get his attention.

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Tax burden? I will send you my bill

2006-07-08T05:35:45Z

I lost my insurance coverage over a year ago after pretty much having it most of my life. I can see now that i took it for granted. Recent experiences have opened my eyes to the "other" side of the American medical system. And it is a mess. The insurance companies aid in deciding what medicines and doctors should charge (and even, in some cases, what they can prescribe). . When the insurance companies say they can raise the price, most do. So, it has nothing to do with "real" cost. Hospitals are businesses for the most part. There are people who work for them who have a sincere desire to help people, but the entity is a business. And they will not hesitate suing anyone for money they didn't get because they overcharged or you did not have insurance. And they do not care. It is now becoming more and more common place for people to have very large medical debts on their credit report. I worked very hard to keep my credit report clean. It is destroyed now. I have to wonder how many people die, or how many people are suffering from inadequate or no health care. I was given a list of "free" clinics (or ones that will work with those who don't have insurance) from two local hospitals (one in Independence and one in Shawnee Mission), but after calling them could not get in unless I had AIDS or was pregnant (which neither is a problem for me). And that was a general response from those that actually answered the phone. Then I was referred to doctors that i could not afford......and that list is very long. American politicians want to spend time debating issues like a war across the ocean, the price of gas, and their own salary increase while there are many Americans across the country that just want to be healthy. And, anyone who says that health care for everyone is just to much of a tax burden is more than welcome to pay my medical bill.

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Health care made harder to get

2006-07-06T05:00:00Z

Thursday, July 6, 2006

Health care made harder to get

By REGINA OWENS

Starting this month, when you apply for Medicaid, take your passport along with you. Thanks to federal legislation passed in February, if you need health insurance, you're going to have to work hard to prove you're a citizen.

This represents a big change and a big burden. A passport costs almost $100, not a small amount for anyone. As an alternative, you can buy a birth certificate ($28) and a state identification card ($20) -- and bring along proof of your limited income.

With more than 45 million uninsured people in our country -- more than 850,000 every year in Washington -- we need to make it easier to enroll in health insurance, not harder.

It's no leap to see that homeless people will be denied coverage and seniors will lose out on nursing home care. Victims of natural disasters, like those who survived Hurricane Katrina, will have to pack birth certificates if they hope to get treatment. Parents juggling multiple low-pay jobs will find it much harder to get the insurance they and their families need.

What the new law doesn't change are the eligibility requirements for Medicaid. Undocumented immigrants already were ineligible for anything but emergency coverage and even many non-citizens with immigration status are ineligible, too. The doors to health care were already shut to them.

There's also no evidence that non-citizen immigrants are claiming U.S. citizenship to receive Medicaid. The Department of Health and Human Services' inspector general investigated and found no reason to change the current citizenship verification system. The Centers for Medicare and Medicaid Services reached the same conclusion.

In Washington, the state may help people gather documentation, but it will still be a costly and daunting process when there's no "problem" to be solved.

So why all the talk about immigrants and Medicaid?

It's the result of flames of mistrust and panic stoked by nativists groups who are using many people's rightful concern over health care and family budgets to push them into the nativists' camp.

That's a plunge that Washington Citizen Action is not willing to take. We have long been a champion of health care for all Washingtonians, and many of our members have disabilities or chronic conditions. We worked to win the state's groundbreaking Patient's Bill of Rights, the state's prescription drug purchasing pool and health insurance for solutions for small businesses.

And we know we're not going to solve our health care crisis by scapegoating immigrants, documented or not.

Immigrants and the U.S.-born alike are going without desperately needed health care. Immigrants and the U.S.-born are being burdened by medical debt, watching employers drop coverage and seeing their financial security erode.

Why is this situation occurring? We put enough dollars into our fragmented health care system to cover everyone. But nearly one-third of our health care dollars go to administration, and billions more feed excessive prescription drug prices and "boutique" clinics.

If we're looking for a real problem to solve, that's a good place to start.

Regina Owens is a state board member of Washington Citizen Action, a grass-roots health care lobbying organization. She is also a Medicaid recipient.

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Massachusetts Becomes First State to Achieve Near-Universal Health Coverage

2006-07-05T17:14:03Z

Date: April 18, 2006
Contact: Dave Lemmon, Director of Communications
Geraldine Henrich-Koenis, Press Secretary
202-628-3030

Massachusetts Becomes First State to Achieve Near-Universal Health Coverage

Massachusetts recently enacted landmark legislation designed to cover almost all of the state residents who are currently uninsured. Families USA is hosting today’s briefing at the National Press Club to explore the possible national implications of this historic legislation. The following is the statement of Ron Pollack, Executive Director of Families USA, about that legislation:

“The landmark health care legislation recently passed by the state of Massachusetts will make health care coverage more affordable for working families and small businesses in the state. This initiative takes the unprecedented step of expanding health care coverage to virtually everyone in Massachusetts.

“Within three years, this groundbreaking legislation will guarantee affordable health insurance coverage for 95 percent of the state’s approximately 550,000 uninsured citizens.

“As the first state to enact health reform legislation that will achieve near-universal health coverage, Massachusetts may become a model for other states and the federal government. Some critical aspects of the plan—such as the size of premium subsidies and the definition of ‘affordable’ for people subject to the individual mandate—are critically important and remain to be determined. They are essential details that will make a big difference in assessing the success of the plan.

“Massachusetts’ achievement demonstrates that by working in a bipartisan manner, we as a nation can make health care more affordable and accessible. This approach is promising because it offers a mixture of public and private solutions to achieve the goal of affordable health care coverage for workers and small businesses.

“In this current political climate, the only way to make significant headway on the problem of the uninsured is to find ways we can cobble together different approaches that pave the way for the ultimate goal of universal coverage.”

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Hospitals are a Business.

2006-07-05T05:04:11Z

That's just the way it is. There may be people on the staff that have true compassion for people and their health, but the hosptal as a whole it nothing more than a business out to make money. And not just a little money. A lot of money. An overnight visit at Shawnee Mission Hospital here in Kansas City cost $15,000. That didn't include the tests or doctors....that was just the stay. Shouldn't I have gotten room with a fridge and a pool and suana for that? Ot steak dinner with wine? I could have gotten the same care at the Motel 6 and just walked over for my tests. That would have only cost me about $60.

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