Enemies of Reform
How Many More Have to Die Before We Fix Health Care?, Part 1
Published August 03, 2009 @ 05:20PM PT
In the movie Excalibur, the wizard Merlin intones, “When a man lies, he murders some part of the world.” Dramatic, but rarely true. That’s perhaps what makes the current “hold no stops/make up what you have to” tactic of the enemies of reform so galling. By now, you’ve heard the fabrications. You’ve seen career political opportunist, corporate schill and “close reading” policy hack Betsy McCaughey proclaiming that the health care reform bill would pressure senior citizens to die faster – causing NPR’s On the Media to report, “That is shocking — also, utterly untrue.” That didn’t stop Rep. Virginia Foxx from proclaiming on the House floor that the Republican alternative to health care reform (anyone know what that is today? It changes so frequently… Is it just more tax cuts again?) “is pro-life because it will not put seniors in a position of being put to death by their government.” Politics is a rough and tumble sport, but it is the height of irresponsibility to purely frighten senior citizens based entirely on a lie.
What makes it even worse, though, is this political posturing ignores the fact that people are dying this year, this month, today because we keep putting off fixing our broken health care system. If these smear tactics succeed, then lies truly will have killed part of our worlds.
I want to tell you the story of three people. They didn’t know each other. I didn't know them. They were young, they were beautiful, and they were loved. And they have all died within the past two months because they could not afford health care.
You can read the story of Edith Speed in her own words right here on Change.org. She had insurance for over 10 years when she was diagnosed with breast cancer – specifically intraductal and infiltrating duct carcinoma. It was bad enough going through the terrifying experience of dealing with breast cancer. But that wasn't all she was forced to deal with.
The bills began to arrive, from 10 different entities, my surgeon, her assistant (whom I'd never even met, and who I learned was not a preferred provider for my health plan), the anesthesiologist, the hospital, radiology, the lab, you name it, they're billing me. I learned more than I ever wanted to know about the adversarial relationship between hospitals and the insurance company, I learned that there are many necessary procedures that the insurance company won't pay for, leaving the patient holding the bag after the fact, I learned that my deductible which on paper is $2,500.00 per year, is actually a $5,000.00 per year maximum out of pocket expense. My 2 hour procedure cost $35,000.00.
I was glad I had kept my insurance, which I'd had for over 10 years. I'd never had occasion to use it and had been thinking it was a huge waste of money, only a month before, I'd considered dropping it. I put one of my two cars up for sale, cashed in my U.S. Treasury bonds, left to me by my aunt, and began to dip into the savings account I'd started towards a down payment on my house.
But then the cancer got worse, and Edith needed a radical double mastectomy. And she was flat broke. She thought of just giving up the fight and letting the cancer take its course. Instead, she found the inner strength to found the Bowling for Boobies charity event. After her own medical debts were paid, she organized it every year to help more women in her condition, and went on to found the Busted Foundation to financially support women with breast cancer.
So it’s a painful tragedy that someone who gave so much would be faced with breast cancer again. In April, Edith wrote, “Six years later, I am glad to have made the choices in care that I did, happy to be well and so immeasurably grateful to have had the support network that I do. Still, six years later, my husband and I have not recovered from the financial hit. Our savings remains depleted and I have come to terms with the fact that we may never own a house. Time has passed, my life has gone on and while I am happier than ever, a dark cloud looms in the distance of my consciousness.”
Fighting here own dark clouds, Edith inspired so many people. Her friend Christa Faust wrote, "She was a breast cancer survivor, a strong, beautiful Domina and a warm, supportive and generous friend for over fifteen years. She was there for me during a very hard time in my life and I can’t stop thinking I should have done more to be there for her."
In the words of her friend Lisa Derrick, “On June 7th that dark cloud became overwhelming and Edith killed herself.”
In no other industrialized country is the amount you can spend on out-of-pocket health care costs infinite, even for those with insurance. In no other industrialized nation do you have to give up your financial security to save your life. Only here. Only because we still haven't fixed health care.
Go to Part 2, and learn about Angel "Inqy" Yates and Eric De La Cruz.
(Photo credit: bethboya on Flickr.)
My "Freedom" Is More Important Than Your Health: Privilege vs. Progress in Health Care
Published August 02, 2009 @ 11:24PM PT
People have been emailing me a piece by Shawn Tully, the Editor-in-Chief of Fortune Magazine, entitled “5 Freedoms You’ll Lose Under Health Care Reform,” which was featured on the Drudge Report last week. In sending, they've asked for me to respond. I struggled most of the weekend with a response, not because I agree with Mr. Tully – I don’t – but because the world Mr. Tully describes is not one that’s accessible to most Americans, and certainly not accessible to me. Although he’s been able to tap into the scary narrative of “health reform will cause you to give something away,” he’s particularly focused on what the rich will have to give away, and doesn’t seem to have a real sense of the hazards of the current abusive insurance marketplace. Every single one of the freedoms he defends either will continue to exist under health reform or, most often, currently only exists to the tiniest percentage of hardworking Americans.
Shoring up the foundation is apparently not a good idea if it rattles the penthouse. Any student of history should immediately recognize the dynamic – it is the sense of entitlement and privilege standing in the way of progress, yet again.
Now I don’t for a second think that the supporters of Mr. Tully’s work will be won over by my arguments. After all, Mr. Tully wrote a piece in March of 2008 entitled, “Why McCain Has the Best Health-Care Plan.” Indeed just about every position Mr. Tully takes in his new editorial reflects something cherished about John McCain’s plan or, in the case of Health Savings Accounts, George Bush before him. If Mr. Tully had been John McCain’s speechwriter, perhaps the plan would have been better received. Or perhaps, as always, it’s easier to trigger the public's fear of loss than it is to trigger their hope for a better future, particularly on a topic as complicated as health care.
In the end, I can’t help but look at what he calls “freedoms” and think “Who, exactly, has these now?”
His first is “Freedom to choose what’s in your plan.” But 160 million Americans don’t have that – their benefits are offered through their employer and determined by their employer. Millions more have some government program – Medicare, Medicaid and SCHIP, or perhaps the VA or the Department of Defense – whose benefits are determined by law. The remaining people are either uninsured and have no choice on what’s in their absence-of-a-plan, or are in the individual insurance market. The individual insurance market is one that Mr. Tully championed explicitly in his support for John McCain’s plan. However, the experience of those purchasing from this free market ideal on Earth tell a different tale. A large portion of them do not get to choose what’s in the plan either. A recent report by the Commonwealth Fund found:
Seventy-three percent of people who tried to buy insurance on their own in the last three years did not purchase a policy, primarily because premiums were too high. In addition, among adults with individual coverage or who tried to buy coverage in the past three years, 57 percent said it was very difficult or impossible to find coverage they could afford, 47 percent said it was very difficult or impossible to find a plan with the coverage they needed, and 36 percent were denied coverage or charged more because of a pre-existing condition, or had the condition excluded from their coverage.
So I’m afraid if you’re not a CEO or in human resources, you’re not enjoying this “freedom,” unless you happen to be the lucky fraction of a percentage who makes a deal with an insurance company for the coverage you want. The irony with Mr. Tully’s argument is that it ignores that in both the Senate Health, Education, Labor and Pensions bill as well as HR 3200, individuals and employees at small businesses will in fact be able to determine whether they want the standard level of coverage or some additional items at higher cost (the "premium" level benefit options). Apparently he only counts it freedom if you can remove some of your coverage, not gain more coverage that is currently unaffordable to you.
In this, Mr. Tully’s spirit of self-determinism truly takes an odd shape. He decries the fact that a minimum standard of benefits will be set by the government. “The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services,” he says – perhaps unaware of the fact that mental-health benefits and substance-abuse services are already a federal mandate. Freedom to choose your plan, in his mind, means the ability to chuck coverage to save money. To be sure, both the insurance industry and business have spent several years trying to do just that. American citizens, on the whole, have not. It is extraordinarily difficult to go onto the blogosphere, attend a town hall, or find a feature story in the mainstream media whose thesis is, “Woe is me. I have too much coverage for health care.”
Krugman, Sarcasm and Soylent Green: The Best of the Weekend
Published August 02, 2009 @ 05:53PM PT
Every Sunday, I’ve taken to posting the best of the best – the three must-reads or must-watches that will really help you parse what’s going on. During the presidential campaign, we took to calling the period where the importance of what was covered was in inverse proportion to the frequency with which it was covered “silly season.” This week, the focus seemed to be on – well – beers at the White House. ‘Nuff said.
So here are the three weekend articles you won’t want to miss to remove some of the silliness from your coverage. As we move into August, the misinformation begins to fly. Most of it will be reported as “he says/she says” by the news – two sides of an argument that deserve equal weight. But as these writers show, there’s a big difference. One side is looking to address the problems of our broken health care system, and the other is trying to make it seem as confusing and hopeless as possible.
If there’s a silver lining, it’s that so many great writers are determined not to let the agents of the status quo have the last word.
1.) Paul Krugman – “Health Reform Made Simple”
I’ve lost track of the number of people who have asked why there can’t be a simple 2 page description of what’s going on in health care reform and then, when I start to explain it in as simple terms as I know how, stop me with questions that get both deep and technical. Of course, the deep, technical questions are how it’s supposed to be – participatory democracy should involve meat and not just baby food. But it does point out an interesting fact – it’s easy enough to debate health care reform in a couple of hours or in a 100-page document. It’s tough to debate it in a few minutes and 500 words.
But just as I comforted myself with that notion, Paul Krugman delivers the best and most succinct explanation of health care reform you can imagine. And yes, it’ll take you minutes to read:
The essence is really quite simple: regulation of insurers, so that they can’t cherry-pick only the healthy, and subsidies, so that all Americans can afford insurance. Everything else is about making that core work…
That’s it. Any commentator who whines that he just doesn’t understand it is basically saying that he doesn’t want to understand it.
Read the whole blog post here.
2.) Jonathan Alter, “What’s Not to Like?”
Satire is the art of turning a preposterous argument on its head to demonstrate its truly silly core. With this Newsweek article, subtitled “Reform? Why do we need health-care reform? Everything is just fine the way it is,” Alter undresses what is beginning to become a popular argument of saying the convoluted, wasteful, prohibitively expensive and abusive American health care system doesn’t need fundamental change. It’s an argument so at odds with the experience of most Americans when dealing with an illness or injury that it deserves what Alter gives it – sarcasm:
I had cancer a few years ago. I like the fact that if I lose my job, I won't be able to get any insurance because of my illness. It reminds me of my homeowners' insurance, which gets canceled after a break-in. I like the choice I'd face if, God forbid, the cancer recurs—sell my house to pay for the hundreds of thousands of dollars in treatment, or die. That's what you call a "post-existing condition."
I like the absence of catastrophic insurance today. It meant that my health-insurance plan (one of the better ones, by the way) only covered about 75 percent of the cost of my cutting-edge treatment. That's as it should be—face cancer and shell out huge amounts of money at the same time. Nice…
Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies—not doctors—decide what's reimbursable. After all, the insurance companies know best.
Read the whole article on Newsweek's site.
3.) The White Coat Underground, “Health Care Reform – How to Obfuscate, Confuse and Inflame”
I wasn’t following this blog but, after this post, it’s a must have on my RSS reader. PaulMD is an internist in the Great Lakes region, and he knows malarkey when he sees it. The new constant refrain (the new “socialized medicine is bad,” if you will) of those who would like to continue profiting financially and/or politically from the current inefficiencies of our health care system goes something like this: the government will overrule your doctor. The supposed villain is comparative effectiveness research. Well, it just so happens that PaulMD is a doctor. His diagnosis of this fear-mongering argument? It’s baloney:
How does [Betsy McCaughey] justify this unjustifiable conclusion? She doesn't. She simply asserts it. "Comparative effectiveness" is an au courant term used to describe research that looks at medical practices and tried to assess its effects. For example, there are two surgical ways to fix blood flow to the heart muscle: percutaneous coronary interventions (PCIs) such as angioplasty and stenting, and coronary artery bypass grafting (CABG or "heart bypass"). I'm not going to teel you which one is better, because the answer is complicated and still being investigated, but to choose the correct therapy for a patient we must answer a number of questions: which works best in which kind of patient; how long does each last; which has lower complication rates; which leads to longer survival; which leads to longer survival without additional need for a second intervention; which costs more, and over what time period; which makes people feel and function better. These questions and others need to be asked about many of the things we do, and comparative effectiveness research is a reasonable way to approach this.
To ignore these questions because we don't like the answers is so frighteningly ignorant that it's hard to believe an intelligent person could suggest it. Knowing these answers doesn't mean it's time to start making Soylent Green. What we do with the information is where our ethics as individual and as a society are tested. If we find that kidney dialysis in eighty year olds on average does not provide much quality or quantity of life, do we decide to stop covering it? Do we create algorithms for deciding what do offer an individual? Do we make a subjective choice in each case?
(Photo credit: taekwonweirdo on Flickr.)
Is Health Care Going Too Fast? You're Kidding, Right?
Published August 01, 2009 @ 08:54AM PT
GOP strategist Alex Castellanos issued a memo on how Republicans could defeat health care reform which explicitly promises, “If we slow this sausage-making process down, we can defeat it.” Unsurprisingly, the phrase “Slow down, Mr. President” is showing up everywhere, from RNC Chairman Michael Steele’s speeches, to even comments on this blog. The latest – and far from the last – iteration of this poll-tested Karl Rovian attempt to kill reform is that members of Congress have not even read the bill fully. That, we’re told, shows we’re disastrously rushing the process and will get it wrong.
To which I say, “You’ve got to be kidding.”
Let me be clear: I firmly believe that every member of Congress should read the health care reform bills that passed out of committees in the House and the Senate. If they can’t, hire staffers who can and summarize it for you. If you can’t hire staffers who can, hire speed-reading temps who can. If you can’t even commit to hiring speed-reading temps who can for reforming 16% of our economy, chances are you shouldn’t be making decisions in a representative government, dude. Let me put it this way – Harry Potter and the Deathly Hallows is nearly 800 pages long. I know people who read that in less than a week – and they weren’t getting paid to do so!
But even as someone who expects a lot out of my representatives, I find this “we’re moving too fast” argument to be pure, disingenuous baloney.
Speed is a relative term, after all. Let’s take a quick jaunt down memory lane to 2004, to an op-ed written by Rep. Brian Baird (D-WA) about a Republican-controlled Congress’s need for speed:
Current rules require that bills be available to be read for at least three days before coming to a vote. Unfortunately, those rules are routinely overridden by the Republican majority, leaving only a few hours to read bills that are thousands of pages in length and spend hundreds of billions of the people's dollars.
There is now an inverse relationship between the importance of legislation and the amount of time members have to study it before voting.
In addition to this latest abuse of power, prominent examples from the 108th Congress include the Medicare prescription drug bill, the energy bill, the intelligence bill and the defense authorization bill. These important pieces of legislation total more than 2,900 pages of text and authorize more than $1 trillion of spending. Yet, collectively they were available to members for less than 48 hours total for reading.
If forced to tell the truth, most members of Congress would acknowledge that they did not fully or, in many cases, even partially read these bills before casting their votes.
OK, that’s pretty damn fast – and many of the people now claiming a terrible rush today were the ones helping to rush back then. Let’s talk about a law which massively curtailed every American’s civil liberties – the USA Patriot Act. Please note, before I’m accused of quoting some liberal media outlet, that the next tidbit is taken from FoxNews.com in 2004: “The Patriot Act, for example, weighs in at 340 pages — svelte by federal legislation standards. Yet the Senate was given just three days to read the bill before voting on it (and approving it 98-1). And just two days after the Sept. 11 attacks, Sen. Orrin Hatch found a pending appropriations bill due for a vote, and tacked on a slew of amendments that served as a kind of precursor to the Patriot Act — again, giving the Senate no time to actually read and contemplate them.”
Let’s contrast that with the comprehensive health care reform bills in Congress. The Senate Health, Education, Labor and Pensions bill dropped July 9 and was voted out of committee with much fanfare on July 16. That’s 38 days. The House Tri-Committee bill dropped on June 19 and was voted out of its last committee last night. That’s 43 days. Plus, we now have a luxurious August recess, meaning the earliest anyone will be voting for HR 3200 is around 44 days from now – a grand total of 87 days.
Sure, HR 3200 weighs in at around 1,000 pages (and let’s just mention it’s in a pretty big font). Are you telling me the staff of our elected representatives cannot read 11 pages a day?
All snarkiness aside, the chorus of slow down, delay and deny is not just a transparent attempt to kill the momentum for comprehensive health care reform. It’s playing politics with the lives of our fellow countrymen. As Health Care for America Now points out, in just three weeks:
* 143,250 people will lose their health insurance coverage [pdf]
* 53,507 people will file for bankruptcy because they can't pay their medical bills
* 1,265 people will die [pdf] because they lack coverage
So are we going too fast? If you ask me, we’re a couple of decades too late already.
(Photo credit: Steve Rhodes on Flickr.)
Happy Birthday, Medicare -- the Most Popular Kid on the Block!
Published July 30, 2009 @ 11:47PM PT
Forty-four years ago today, LBJ signed Medicare into law. At the time, 40% of the elderly did not have health insurance. A third of them also lived in poverty. Today, everyone in the country over 65 has a basic level of health security that those of us under 65 still do not enjoy. How to evaluate Medicare on its birthday? Let’s start with this – it’s worked.
The Commonwealth Fund published a study in Health Affairs which can be summed up in a single sentence, “Compared with the employer-coverage group, people in the Medicare group report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage.” Make no mistake, Medicare doesn’t score perfectly. I'm positive you can find bad stories (although a colorful anecdote is never as relevant as years of hard data). In fact, 8% of beneficiaries rated their coverage “fair or poor,” but that’s a pretty good number – way better than the 18% private insurance got. The same study showed that reported problems of access to care increased from 12% in 2001 to 18% in 2007 – but private insurance in 2007 was at a shocking 45%. And, in keeping with the moral reasons for which Medicare was first founded, only 14% reported a problem paying bills – better than the 35% for private insurance, and the presumably 80-100% of the uninsured. Note that this holds true even though the Medicare patient base is, by definition, older, sicker and usually poorer than those in private insurance.
National Journal, hardly a bastion of liberal thought, comes to the same analysis in regards to Medicare’s popularity. In their analysis of data from the Consumer Assessment of Healthcare Providers and Services, they found that 56% of Medicare beneficiaries rate their coverage a 9 or 10 on a scale of 10 (only 40% for private insurance.)
More importantly, the higher scores for Medicare are based on perceptions of better access to care. More than two thirds (70 percent) of traditional Medicare enrollees say they "always" get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in Medicare managed care plans and only 51 percent of those with private insurance.
There are, of course, problems – as there are with any health care system. I’ve gone on at length in other posts about the problems with the fee-for-service reimbursement system, long-term care, and problems associated with the prescription drug plan and Medicare Advantage private HMOs. As the cost of all U.S. health care outpaces inflation, so does Medicare. Since 1970, Medicare costs have risen 8.8% per year. That’s bad, no question, and unsustainable. But over that same time frame, private insurance went up 9.9% per year. Not bad for a government-run program!
In a political climate where once again we’re being told government can’t run anything, people are responding in the most peculiar way. President Obama said at a town hall this week, “I've received letters that say, I don't want a government-run program, I don't want socialized medicine, and by the way don't touch my Medicare.” Old reliable government-run Medicare has a golden name. If you want to build on what works, you start with Medicare. Hence, single-payer health care is Medicare for All. When John Edwards and Hillary Clinton pitched their versions of the public health insurance option, they called it, “a public plan, similar to Medicare.” We’re witnessing a revolt by progressives in the House right now against the deal struck with the Blue Dog Democrats about how close the public option will get to Medicare, with a letter of protest proclaiming, “Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates – not negotiated rates – is unacceptable.”
Of course, what’s old is new again for the opposition, as well. Ronald Reagan was the most famous opponent of Medicare’s passage, claiming, “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” Classic. Today’s fear-mongering pales in comparison. It’s somewhat surprising to see Republicans so desperate to stop health care reform that they’re willing to demonize and fear-monger one of the country’s most popular programs. But this week, we’re hearing from Rep. Roy Blunt (“Medicare has never done anything to make people more healthy”) and Rep. Tom Price (“nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare”), all in the same week that conservative after conservative takes to the floor with the most recent big lie about health care reform: Rep. Foxx’s mendacious declaration that reform would “put seniors in a position of being put to death by their government.”
They ought to be ashamed of themselves – really and truly ashamed of themselves – that they’re so willing to say and do anything that they’ll bring back memories of the bad old days, when if you were old and poor there was no care for you and too many seniors had little choice other than death. The bad old days, when the number of those over 65 was half what it is now, and life expectancy over 65 was nearly 4 years shorter. The bad old days, when too many saw “illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”
As Foxx and Blunt and Price should know all too well, we finally found a way to end the nightmare conditions they warn about. We instituted a government-run program named Medicare. And that has made all the difference.
Bill Moyers, Ezra Klein and the NY Times: The Best of This Weekend
Published July 26, 2009 @ 07:54PM PT
The best part of being semi-obsessed with health care policy and politics is we’re truly living in a flood of information. Every Sunday morning talk show, every newspaper, every political blog is talking about health care to one extent or another. The bad part is that a lot of the stories are “the same old stuff” – political theater and horserace stuff that doesn’t actually contribute to a greater understanding. Do we really need to know that President Obama is saying the same things in private to Chuck Grassley that he said back publicly back in March? Did anyone learn anything new from David Axelrod? Do we really need another, “Gosh, Obama has a lot to lose if he doesn’t get health care” article?
So every Sunday, I want to post the best of the best – the three must-reads or must-watches that will really help you parse what’s going on.
1.) Bill Moyers Journal – “Debating Healthcare Reform”
Bill Moyers has consistently showcased the voices in our national debate that we should listen to more. Two weeks ago, he hosted a riveting interview with former Cigna executive Wendell Potter, who’s made it his mission to make transparent the workings of a private insurance that’s focused more on Wall Street than its customers.
This week, he held a but no less important discussion with Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine and one of the best-spoken proponents of single-payer reform in health care, and Trudy Lieberman of Consumer Union and the Columbia Journalism Review. Since so much of the debate this week has focused on whether Obama is looking to change too much about health care, Moyers turns the tables to talk about whether the reform plans being offered will actually change too little. As Moyers reports:
Meanwhile, supporters who want to scrap the present system for fundamental change are staring glumly through the fog of war at a battlefield in total disarray. They fear that in the White House's desire to get a bill -- any bill -- passed by Congress, it will have been so compromised, so bent to favor the big interests, that it will be less Waterloo than water down, a steady diluting of what they'd hoped for, or America needs.
PBS does not allow for embedding videos (come on, folks! It’s 2009!), but you can view the whole episode on their site.
2.) Ezra Klein, “The Ghosts of Clintoncare”
Folks like William Kristol are openly hoping for a repeat of the defeat of Bill Clinton’s health care plan, which helped spike a Republican resurgence and the Gingrich Revolution. Democrats in Congress are openly worried that pushing too hard on health care reform and losing will lead to a backlash like what they went through in 1994. Everyone wants to analyze the current health care fight in the light of Bill Clinton’s political wake.
But until Ezra Klein wrote his piece in the Washington Post this week, few paid attention to the other fallout of health care reform’s failure in 1994 – how we as patients and consumers actually got all of the demerits of Clinton’s plan anyway, but with none of the benefits.
But then a funny thing happened: Managed care came anyway. By last year, only 7 percent of American workers were in "traditional" indemnity health plans, while the rest of us -- or at least those of us fortunate enough to have insurance -- were swimming in the alphabet soup of HMOs and PPOs and HDHPs. We're all in networks now. We don't get our choice of doctor. There's no appeals process. No out-of-pocket caps. Nothing to stop insurers from rejecting our coverage applications based on preexisting conditions. And if we don't like our insurer? Tough.
"We got managed care," says Chris Jennings, who was one of Clinton's top health-care staffers. "But we didn't get the things that would protect us from managed care. We got the Wild West version of it."
Read all of Ezra’s aricle here.
3.) The New York Times editorial, “Health Care Reform and You”
If my inbox and some of the comments sections are any indication, people are hungry for details on the proposals coming out of the House and Senate. But they don’t want spin and they don’t want legislative language. They want to know what’s in it for them. The New York Times offers the longest editorial you’re every likely to read – and they break it down in as simple language as I’ve seen done anywhere:
The health care reform bills moving through Congress look as though they would do a good job of providing coverage for millions of uninsured Americans. But what would they do for the far greater number of people who already have insurance? As President Obama noted in his news conference last week, many of them are wondering: “What’s in this for me? How does my family stand to benefit from health insurance reform?”
Many crucial decisions on coverage and financing have yet to be made, but the general direction of the legislation is clear enough to make some educated guesses about the likely winners and losers.
Read the whole editorial here.
(Photo credit: World Economic Forum on Flickr.)
For-Profit Insurance Needs a Hug
Published July 23, 2009 @ 10:17PM PT
Much to the chagrin of those who have championed a single-payer system for years or even decades, the mantra of the debate in Washington is “If you like what you have, you can keep it.” But of course opponents of reform are telling anyone who listens that you won’t be able to keep your private insurance, that Big Government is coming to beat on private insurance unfairly, and that the real solution to our health care woes is to leave what Jon Stewart of the Daily Show referred to (tongue-in-cheek) as a “benevolent free market operator” alone. Are the forces of the status quo onto something? Should we have more sympathy for private insurance?
Claim #1: Private insurance is in rough enough shape in this economy – it shouldn’t be forced to compete with a public health insurance option.
Of all the sectors in the economy, health insurance seems to be doing pretty damn good. I’m basing this on the story two days ago that UnitedHealth Group, the largest commercial insurer in the country, more that doubled its profits from Q1 to Q2 and completely beat all Wall Street expectations. At $859 million of pure, red-blooded profit, it’s more than double the $337 million it made over the same quarter last year. That’s right, the bellwether for for-profit insurance has made more profits since the financial crisis than it did before – a 154% increase, in fact. Of course, some might claim this number is misleading. After all, last year’s Q2 profit might have been even higher – if it weren’t for those pesky class action lawsuits that cost it an additional $922 million in fines.
If you’ve been reading, the obvious question is how, at a time when more and more employers are dropping health benefits and millions have lost their coverage with their jobs, how is UnitedHealth actually doing better? Their explanation: “’We expect this year's revenue growth in public and senior business to continue to more than offset the potential for further pressure from the employer market,’ UnitedHealth CEO Stephen J. Hemsley said in a conference call with analysts.” Yes, that’s right. They’re making up for a 6% dip in employer-based customers with Medicare Advantage plans – which already compete directly with standard government-run Medicare – and through administering Medicaid HMOs.
So the industry that needs to be protected from government health programs is currently leveraging government health programs to achieve record-setting profits.
Claim #2: People love their for-profit insurance.
Yesterday’s Washington Post mentions how often Karen Ignagni of AHIP mentions that 77% of people like their insurance and presumably want to keep it. But then it goes one step further – and actually provides the context:
But the polls are not that simple, and her assertion reveals how the industry's effort to defend its turf has led it to cherry-pick the facts. The poll Ignagni was citing actually undercuts her position: By 72 to 20 percent, Americans favor the creation of a public plan, the June survey by the New York Times and CBS News found. People also said that they thought government would do a better job than private insurers of holding down health-care costs and providing coverage.
In addition, data from a Kaiser Family Foundation poll last year, compiled at the request of The Washington Post, suggest that the people who like their health plans the most are the people who use them the least.
Those who described their health as "excellent" -- people who presumably had relatively little experience pursuing medical care or submitting claims -- were almost twice as likely as those in good, fair or poor health to rate their private health insurance as excellent.
That, of course, is the funny thing about something like health insurance – it’s impossible to tell how good it is until you actually need it. And then the lesson can be painful, if not deadly.
Claim #3: People should be allowed to continue purchase individual plans outside of the Exchange.
This is what the “Page 16” brouhaha is about – the conspiracy theory that private insurance will be made illegal if the House bill passes. Not at all. When the Health Exchange is set up for individuals and small businesses to purchase coverage, most of the plans offered will be private insurance – they’ll just be more tightly regulated, required to provide a minimum standard of benefits and spend a fixed percentage on health care costs, and come with a subsidy from Uncle Sam if you can’t afford it. If the individual insurance market plans have the same minimum standard of benefits, the company can keep selling those as well. Now keep in mind, the individual insurance market only has about 16 million customers right now – and almost all of the companies that offer it are likely to have an Exchange plan post-reform. How shifting 16 million customers from one private insurance plan to another (and a subsidized one at that) will put private insurance out of business is beyond me.
People have still rushed to individual insurance market’s defense. So let me make this clear – it doesn’t deserve it. The L.A. Times reports on some findings from the Commonwealth Fund:
…among adults ages 19 to 64 with individual coverage or who tried to buy individual coverage in the past three years:
-- 47% found it very difficult or impossible to find coverage they needed.
-- 57% found it very difficult or impossible to find affordable coverage.
-- 36% were turned down, charged a higher price, or excluded because of a preexisting condition.Ultimately, 73% never bought a plan.
The report also found that:
"Even people enrolled in employer-based plans are spending larger amounts of their income on health care and curtailing their use of needed services to save money."
Even if you believe that for-profit insurance as a whole gets a bad rap, there is nearly nothing defensible about this niche of the market. If only 27% of customers who need your products can actually buy them, you’re a failure – pure and simple.
Let’s not pretend. Private, for-profit insurance will almost certainly continue to make a profit – at worst, it won’t be able to double its profit margin each year. It will be able to compete with a public health insurance option, particularly the somewhat hamstrung variants that have made it into the actual legislation. The more people have to use their insurance, the less they like their insurance company. And the individual marketplace probably ranks among the most fundamentally broken markets operating in our economy.
Save your hugs for those who are struggling with the high cost of health care in this economy, those who lost their family’s coverage because they lost their jobs, and the families of the 18,000 Americans who will lose their lives unnecessarily this year for no other reason than because they couldn’t afford health insurance.
(Photo credit: kalandrakas on Flickr.)
