The Uninsured and Underinsured
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5 Steps to Get Americans on Board With Health Reform
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The Senators -- and the Yankees -- Need to Get On With It
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6 Treats in the New House Health Care Bill
New Healthcare Versus Old Healthcare: Mirror Images?
Published October 12, 2009 @ 06:00AM PT
This weekend I was in the Bay Area for a trail race, but I got to experience more than the scenic views from the Oakland hills. The bonus was a personal evaluation of Berkeley’s emergency care (yes, only a healthcare consultant could possibly see it that way.) It earned a “C”, meaning it was average US healthcare: not really good, not terrible, and anxiety-producing for all the wrong reasons. So what would change under proposed healthcare reform?
First, some background. For two days before the race I had vague abdominal discomfort, but chalked it up to female cyclical issues. A few hours into the race I was no longer able to breathe, much less move, without severe, stabbing abdominal pain. I was bloated, nauseated, lightheaded, and clammy. Later I learned it was a large ovarian cyst, extremely inflamed by the constant pressure of my hydration pack belt. It left me unable to ingest anything so I became dehydrated, which made existing kidney stones symptomatic. My race was over, but the fun had just begun.
Insurance Companies Are Cutting Their OWN Benefits: The Best of the Weekend
Published October 04, 2009 @ 10:10PM PT
Every weekend, I present the three articles or videos that best enhanced my own understanding of the myriad issues wrapped up in our national health care debate. All three selections this weekend made the list for one simple reason: much like the Spanish Inquisition, I don’t think anyone ever expected stories like these!
1.) Bloomberg, “WellPoint Cuts its Own Health Benefits as Recession Trims Sales”
In Will Ferrell’s celebrity-studded and satirical public service announcement, “Protect Insurance Companies,” actor Jon Hamme pointed out that health insurance companies needed to make millions and billions in profits... to pay for health insurance for their employees. Well, it turns out that’s not a joke. Given that WellPoint has also been at the forefront of creating “astroturf” consumer-friendly Web sites, ad campaigns and push polls to activate its customer base against health care reform, one could be forgiven for thinking this is but poetic justice.
The company will also raise deductibles and premiums for some of its employee health benefits, the Indianapolis-based insurer told workers in a memo today obtained by Bloomberg.
WellPoint, like its competitors, has seen health plan enrollment shrink this year as employers cut jobs and benefits amid the recession… In the memo from Randy Brown, WellPoint’s chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. “Your cost per paycheck will probably increase,” the memo said. WellPoint has 42,000 employees.
(By the way, in case you’re wondering what the heck the picture on this post is, it’s a “Medical Data Loss Dress,” designed to incorporate private medical data that WellPoint carelessly left unsecured on its Web site for 13 months. Good times.)
Read the full article on Bloomberg’s Web site.
2.) Swampland, “Bill Frist on Health Bill: I'd Vote For It”
So let me get this straight. Former Senate Majority Leaders for the G.O.P. Bob Dole and Howard Baker not only have spoken in favor of health care reform (and endorsed a plan through the Bipartisan Policy Center that closely tracks the proposals in Congress), but now Bill Frist has, too? This would be the same Bill Frist who was not only one of the Republican Congressional leaders for years, but also was a heart and lung transplant surgeon? The one whose conservative credentials are so rock-solid he nearly ran for president last year? That Bill Frist?
And yet we’re thinking the chances of a Republican not from Maine voting for this same reform bill is between slim and none?
OK, just checking.
However, he strongly supports other aspects of the bill--most notably, its requirement that individuals be required to purchase coverage, if they do not receive health insurance through their employers or under government programs. And he also lauds the provisions that would eliminate practices that allow insurance companies to discriminate against people based on their health history, including pre-existing conditions.
Frist also faults some in his own party for injecting alarmism into the debate. "Clearly, the death panels and public plan arguments have been overblown," he says. Frist noted that Republicans themselves voted for a Medicare prescription drug bill that would have established a version of a public plan--with the government negotiating directly with drug companies--if private-sector competition had failed to materialize.
Read the whole blog post on Swampland.
3.) Nicholas Kristof, “Dad’s Life or Yours? You Choose”
There are so many basic injustices and indignities with the way our insurance industry operates, it’s hard to know where to begin. But clearly at the top of the list is the injustice of rejecting coverage for those with pre-existing conditions -- discriminating against the very population most likely to need health care, because they’re most likely to need care. Kristof today supplies a dramatic example where pre-existing conditions actually impeded two generations from getting the care they need and the preventative care they still might need.
Mr. Waddington has polycystic kidney disease, or PKD, a genetic disorder that leads to kidney failure. First he lost one kidney, and then the other. A year ago, he was on dialysis and desperately needed a new kidney. Doctors explained that the best match -- the one least likely to be rejected -- would perhaps come from Travis or Michael, his two sons, then ages 29 and 27.
Travis and Michael each had a 50 percent chance of inheriting PKD. And if pre-donation testing revealed that one of them had the disorder, that brother might never be able to get health insurance. As a result, their doctors had advised not getting tested. After all, new research suggests that lack of insurance increases a working-age person’s risk of dying in any given year by 40 percent.
“At the time David needed a transplant, the people closest to him couldn’t even offer a lifesaving donation -- for insurance reasons,” said Mr. Waddington’s wife, Susan.
Read the full column at NYTimes.com
[Programming note: This is my last blog post as the primary editor of this cause for Change.org. Thanks for reading! However, I’m leaving you in the more than capable hands of Gillian Hubble. I’ll be guest blogging in this space in the weeks and months to come, though not at my usual frequency. Whether you’re a health care reform skeptic or activist, we are truly in unprecedented times. There simply has never been as good a chance of having a comprehensive health care reform bill passed by Congress and signed by a president. But stay vigilant and stay active -- we still have a long way to go, and much work to do to ensure it’s a bill we can all be proud of.]
(Photo credit: http://www.flickr.com/photos/plurimus/ / CC BY 2.0)
Rep. Grayson and the Face of Uncompromising Reform
Published September 30, 2009 @ 10:35PM PT
If you’ve been watching C-SPAN 3, you’ve seen a Senate Finance Committee compromising away affordability, compromising away shared responsibility, compromising away the public option, even compromising the notion that we should only heavily invest in peer reviewed and evidence-based teen pregnancy prevention programs. But Rep. Alan Grayson’s back-to-back impassioned speeches from the House floor on health care reform gave me a reason to flip back to C-SPAN 1.
I hadn’t planned to write about the comments made by Rep. Grayson at all. As witty as his diatribe about the complete absence of a Republican plan for universal health care was, it was still a diatribe. Somewhat predictably, the same minority party which had rushed to defend Rep. Joe Wilson’s breach of decorum, and who had filled up the House record with fear-mongering and baseless flights of rhetorical fancy about how the public option would “kill people,” and how health care reform would “put seniors in a position of being put to death by their government,” and how the health care bill told seniors to “drop dead,” now rushed to demand an apology against Grayson’s own hyperbolic flourish. We’ve seen this picture before. If we’re lucky, it would become a tit-for-tat. If we’re unlucky, it would be a capitulation. In any case, it would be a distraction.
It may yet prove to be -- but it's not tonight. Say what you want about Grayson, but he gets what this debate is really about. Tonight he took the floor to apologize, not for the feigned injured pride of thick-skinned politicians looking for a partisan advantage, but for those who truly deserve an apology: the Americans who we fail year in and year out because we haven’t fixed health care reform, the Americans who have no other choice but to go bankrupt when they get sick, and the 45,000 Americans who die every year for no other reason than we lack health insurance.
Health care isn’t just a political football. For many, it’s life and death. And it’s about time one of our elected officials stood up and said so!
The Cost of a Health Reform Fail
Published September 30, 2009 @ 06:48PM PT
Robert Wood Johnson Foundation and the Urban Institute today gave us a peek at what lies ahead for the U.S. if we don’t complete the job on health care reform. What does the future hold if we continue to face costs that rise at three times the rate of inflation, and the subsequently depressed wages and increased number of employers dropping coverage or shifting the costs to individuals and families? From 1999-2009, the number of uninsured rose 10 million -- even with an increase in public coverage through SCHIP, Medicaid and Medicare. What will that number be in 2019? What will that do to state budgets? To the federal budget? How will we manage to pay the cost of failure?
To see what trajectory we’re on, you only need to look at where we’ve been. Health care costs have risen an average of 9% for private insurance each year since 1970 (for Medicare, it’s 8%). More and more employers are dropping coverage altogether, or substantially decreasing their contributions. The number for the uninsured, for uncompensated care, for those on public programs will continue to go up -- as will medical debt-related bankruptcies. The trendlines are long-term and irrefutable. So Urban Institute plugged the numbers into their Health Insurance Policy Simulation Model and projected a number of scenarios for each state and the District of Columbia. They presented two scenarios: one where the recession is prolonged, health care costs continue accelerating, and income growth is about the same; and another where we rebound to almost full employment, income growth is brisk, and health care costs don’t accelerate the way they have the past several years.
But even the best-case scenario numbers ain’t that rosy.
It’s the fulfillment of all the anti-reform slogans you’ve ever heard. If you think reform will take away your choices, imagine an America where 57.0-65.7 million have no choices because they're uninsured. If you think reform means losing what you have in terms of coverage, imagine being one of the 20 million Americans who will lose their employer-sponsored insurance by 2019. The why is obvious -- employer costs for health care would more than double in 27 states in the worst-case scenario. That enrollment in government-funded Medicaid and CHIP programs for lower-income Americans will also increase. If hospitals are complaining about a hypothetical public option based on Medicare rates (the versions of the public option in the bills now would not use Medicare rates), then imagine how happy they’ll be with increases in uncompensated care rise from 72-128%.
You may be OK with an increase in the uninsured, and working families and businesses continuing to see more of their budget eaten up by health care costs. But, as the report concludes, “[Uncompensated care] together with the increased spending for Medicaid and CHIP, this would inevitably mean higher taxes even without reform.” Even if we miraculously avoid a tax increase at the federal level through clever accounting or spending cuts, the state tax piper for Medicaid and CHIP must be paid.
So you can continue telling me that we can’t afford health reform. But for me to take you seriously, you’re going to have to show me how we can afford a health reform epic fail.
(Photo credit: http://www.flickr.com/photos/southpaw2305/ / CC BY 2.0)
45,000 Die Each Year Because They're Uninsured
Published September 18, 2009 @ 04:13PM PT
A much-discussed study put out by Harvard Medical School this week contains a shocking statistic: 45,000 deaths each year can be tied to lack of health insurance. The number by itself might not mean anything. But it amounts to a 40% greater likelihood of death than for those with coverage. It also represents a dramatic leap from the original Institute of Medicine study using similar methodology in 2001, where 18,000 deaths were linked to lack of insurance. In short, things are getting worse.
You know your health care system is in trouble when all the trends are in the wrong direction. The cost of health insurance –- which more than doubled in the past decade -– continues to go up. That leads to two out of three businesses contemplating cutting back on benefits and 9% eliminating benefits entirely. Add that to the number of people who lost their jobs and with it their health insurance, and you have perhaps the inevitable end result: an increase in the uninsured, even taking into account an increase in who gets public coverage through Medicaid, Medicare and SCHIP. That means an ever-increasing number of people putting off care because they can’t afford it, more using the emergency room for primary care because they have nowhere else to go.
We know a lot about who wind up being the uninsured. Hint: it’s neither the very rich nor the very poor. 8 in 10 come from families where at least one person works full time. 1 in 8 are children (although thanks to government-run SCHIP, that number is going down). The fastest growing income segment is individuals and families in the $50,000-$70,000 range, overwhelmingly because of a change in their employer sponsored insurance. And as we learn, they have a health risk with an increased chance of mortality comparable to being a former smoker, simply because they can’t afford quality health care.
That’s worth keeping in mind for the weeks ahead as we hit the next phase of the fight in Congress. The main question of health care reform is not just whether the House bill or Baucus bill should become the basis for legislation; it’s not the question of left vs. right; and in some respect it’s no longer even about whether health care was a right or a privilege. It’s about when will we look at the damage caused by not fixing the problem and finally say, “Enough!”
(Photo credit:http://www.flickr.com/photos/ari/ / CC BY-NC-SA 2.0)
Counting the Uninsured in the U.S.
Published September 11, 2009 @ 04:27PM PT
We know from the Census’ report yesterday that there are 46.3 million total people as of 2008 who lack health coverage from an insurance company or a government-run program, including 36 million American citizens and 9.5 million people who are either legal immigrants, green card holders, or undocumented immigrants here illegally. But the closer we come to solving the problem, the more challenges you’ll hear to any and all of those numbers by those arguing against reform. Yes, there are larger questions of who we think should be covered in a responsible, just society and of what our methodology for counting is. These questions are worth discussion and debate. But it shouldn’t move us off a more fundamental question: how is a system in which millions and millions of people -- no matter how you count them -- lack basic health coverage acceptable?
So what are the distinctions? The largest one is documentation status. It’s not clear to me what the difference is between “more than 30 million American citizens”, to use President Obama’s formulation, or the “more than 46 million people” that is more frequently cited. It makes no difference in terms of public health or the economics of our unsustainable health care costs in which the burden of paying for the uninsured is borne by all of us. Communicable disease and emergency room trip-inducing calamities don’t care whether you’re insured or not, of what country you're a citizen, how much money you do or do not have, or your documentation status. It is a pure political wedge issue, agnostic to substantive health and economic concerns, and one on which I’ll have more to write about tonight.
But the strangest argument I’ve heard lately from Orrin Hatch and other conservatives is that we should also throw out any household making above $50,000 a year from the count. The argument is that those people should be able to afford insurance, because they’re solidly middle-class. That just shows how frustratingly naïve the conventional thinking on who is uninsured truly is. It is precisely the middle-income working class that is being put through the ringer by our out-of-control health care costs. The income group between $50,000-$70,000 is actually the fastest-grown segment of the uninsured population. It accounts for most of the increase over the last decade. The reason why has been pointed out by many other writers today –- private, employer-based health insurance is already eroding because of escalating costs. Over the past seven years, we have seen a net loss of 5 million people covered by their job -- a fact usually ignored by those arguing that we shouldn't be in a rush to reform -- and the number of uninsured would, ironically, look much worse if it hadn’t been for the expansion of government-run Medicaid and SCHIP.
As someone who is in that income group myself, there is no mystery as to why these people who should have insurance (at least according to the Orrin Hatches of the world) don’t. The average family plan on the individual market here in New York is not that far off from the national average -- $12,254 according to America’s Health Insurance Plans. That represents 17-24% of income for a family in that range. For comparison’s sake, the Swiss and Japanese utilizing private insurance pay 8-9% of their income on premiums. Combine premiums that have nearly doubled since 2000, making an individual market plan increasingly unaffordable to the middle-class, with an increased likelihood that you will not have benefits offered by their employer, and the numbers explain themselves.
Now combine that with an economic crisis where unemployment shoots up several percentage points, leading to an estimated 6 million people have lost their insurance in 2009, and you have a recipe for disaster. No wonder those arguing against reform don’t want you to pay attention to this income group -- it’s the perfect snapshot of what’s going wrong.
So that opens the door to a different question. How many people should be uninsured in the United States of America, a land many of us to believe to be the greatest country on Earth, where we hold ourselves to a self-evident truth that all men and women are created equal? That answer is easy: zero.
(Photo credit: http://www.flickr.com/photos/aussiegall/ / CC BY 2.0 )
9 New Surprises in President Obama's Speech
Published September 09, 2009 @ 11:09PM PT
A week ago, before tonight’s presidential address before Congress was even confirmed, I asked if President Obama had anything new to say about health care reform. I asked it even knowing that in many ways, it was the wrong question. The reality was he didn’t need to say anything new -- all it needed to be was new for most of the country. All he needed to do was say it better.
Not that the content of the speech being mostly rehash is at all a bad thing. If you read this blog regularly, or even every-so-often, you’re far more deeply enmeshed in the contours of this debate than, I believe, most Americans are. Although Obama’s town halls have been televised, although there was the press conference dedicated to health care, and the night of Q&A on ABC, although there have been op-eds, and blog posts, and Web casts and radio interviews a-plenty, most people just haven’t had the time to follow it. As a result, not everyone knows that the uninsured aren’t just sad unfortunate folks completely unconnected to us, but that our skin is in that game as well, with at least $1,000 hidden cost for uncompensated care for those of us with insurance.
People may know about pre-existing conditions, but they haven’t heard the story of Robin Beaton, the Texas nurse whose acne years prior was used an excuse to drop her health insurance precisely when she needed it the most to fight breast cancer. People know costs are going up but don’t realize, as the president said, “Our health care problem is our deficit problem -- nothing else even comes close.”
And they don’t hear nearly enough, nowhere nearly enough about the moral deficit of not fixing health care reform: “That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.”
Health care reform doesn’t exist in a vacuum. It’s not a good idea because it’s ideological or because the Obama plan is how anyone would build a system from scratch. It’s a good idea only to the extent that it solves an immediate problem. The structure of Obama’s speech was therefore elementary: you need to know the problem first, then you need to know how the solution relates to it, and then you need to be shown how all the stuff the media fixates on -- bipartisanship, “death panels,” illegal aliens, you name it -- how that doesn’t even relate to either the solution or the problem. Did Obama get a big enough audience or make a big enough impression to sway public opinion? Time will tell.
But since novelty is the spice of life, I have to share the nine things that I had legitimately not heard before, either from a policy or political perspective. Not all of them were positive, mind you, but I have to confess that the answer to the question of my earlier post -- does Obama have anything new to say about health care -- is yes.
