Health Care NOW

IN YOUR FACE says Health Insurance Industry

2010-08-17T07:55:00.000-07:00

Health plans' huge earnings spark fallout from politicians
Insurers, however, plan to stick with their strategy of maximizing rates while minimizing costs

By Emily Berry, amednews staff. Posted Aug. 16, 2010.

Health insurance executives say that, despite political backlash toward their profits and pricing, they will continue to push medical spending lower and keep premiums at the greatest possible margin above costs.

The statements came as the seven largest publicly traded health insurers generally reported second-quarter profits above analysts' expectations.

The plans credited lower health spending, in large part due to money set aside for a flu epidemic that wasn't as bad as expected, and in part because even insured patients were spending less on health care. The plans also credited their own "pricing discipline" -- keeping premiums as high as possible, even at the risk of losing members and standing with politicians.
During a second-quarter earnings conference call between UnitedHealth Group executives and investment analysts, Citigroup's Carl McDonald asked if the company was bracing for more resistance to rate increases and "pricing to trend" -- setting premiums higher as medical costs rise, allowing for consistent or even growing profit margins.

Given the political environment and the company's historic profit margins, which he cited at 7%, McDonald wondered if UnitedHealth Group could keep up those price increases. United said, yes it can.

■Higher premiums, higher profits
■Coventry takes hit from class-action lawsuit
■See related content
"I think that you can still price to trend. I think that is the appropriate long-term positioning of the organization," CEO Stephen Hemsley said.

Five of the seven largest shareholder-owned health plans -- Aetna, Health Net, Humana, UnitedHealth Group and WellPoint -- reported profits in the second quarter of 2010 better than the same period in 2009.

But all seven companies raised their estimates of the total profit they will bring in for the full year.

Net income for the quarter ranged from $1 million for Coventry Health Care to $1.1 billion for UnitedHealth Group. Coventry was charged $278 million for a class-action lawsuit settlement regarding its workers' compensation business in Louisiana.

United's per-share profit of 99 cents was up 37% from the same quarter in 2009, but that wasn't even the largest increase among the biggest seven insurers. Aetna reported earnings of $491 million, or $1.14 per share, a 48% jump, Humana and WellPoint reported a 20% jump in per-share earnings compared with the second quarter of 2009. Coventry earnings would have been up without the settlement.

Cigna's health insurance business did better than expected, but the company saw earnings drop because of losses in nonhealth business.

5 of 7 largest shareholder-owned health plans reported higher 2nd quarter profits in 2010 than in 2009. Most of the big health plans lost members and brought in lower revenue than the prior year but were still able to make a profit because of lower medical spending. For several insurers, a milder-than-anticipated flu season made a critical difference to earnings, allowing them to count as revenue money that had been set aside, but not spent, for the influenza A(H1N1) pandemic. For some plans, such as WellPoint, that turned around what would have been a profit decline from the second quarter of 2009.

Insurers also credited their care management programs and continued economic pressure that appeared to keep members from spending on care.

However, the debate over rates and the potential for further backlash as new health system rules take shape tempered investors' response to health plan earnings.

U.S. Reps. Pete Stark (D, Calif.) and Jan Schakowsky (D, Ill.) released separate statements demanding that insurers lower premiums in light of recent rate increases. They are co-sponsors of legislation, introduced July 22, that would establish a public health insurance option to be included in health insurance exchanges created by health system reform.

Schakowsky said the "windfall" quarterly profits "are the umpteenth example of why this industry needs to be checked."

Coventry and Cigna were the only plans Stark didn't mention by name in multiple releases chiding health plans. He put out a release July 28 slamming WellPoint, Aetna and UnitedHealth Group, then followed up with statements on Humana's Aug. 2 earnings report and Health Net's Aug. 3 earnings report.

"Last week we found that WellPoint and Aetna were reaping hundreds of millions more in profits while spending hundreds of millions less on health care," Stark said in the Aug. 2 release.

"Today's report shows another insurer having a banner year. I await announcements by Humana and other insurers that they will be passing along these billions to consumers in the form of lower premiums."

That doesn't appear to be in the cards. Angela Braly, WellPoint's CEO, president and chair, said during her company's quarterly conference call that she's confident her company will be able to get future rate increases approved despite resistance in some states in 2009 and 2010 -- most famously, in California, where a proposed 39% maximum increase for individual plans was credited with relighting the fire to get health system reform passed.

"We expect that over time, appropriate rates will be granted in order to sustain this important market segment for the many Americans it will serve," Braly said. "This market is projected to expand by 16 million people during the next decade as a result of health care reform, and creating a fundamentally sustainable marketplace will be critical."

The American Medical Association was critical of health plans after the release of the earnings reports, citing numbers that show rate hikes outpacing health spending overall and physician services in particular.

"Huge premium hikes and windfall earnings from the health insurance industry are out of step with the latest figures showing the slowest rate of growth in U.S. health care spending in nearly 50 years," said AMA Immediate Past President J. James Rohack, MD. "Spending for physician and clinical services grew 5%, the slowest rate of growth since 1996.

"While insurers propose double-digit price increases, the latest figures show prices for physician services increased by only 2.7%. In fact, inflation adjusted physician fees decreased by 25% between 1996 and 2006. More oversight is needed to make certain that insurers are not funding their multibillion-dollar merger and acquisition strategies on the backs of patients, physicians and employers."

The print version of this content appeared in the Aug. 23 issue of American Medical News.

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ADDITIONAL INFORMATION:
Higher premiums, higher profits
Most of the seven largest shareholder-owned health plans took in higher profits in the second quarter of 2010 than the same period in 2009, despite declining membership and lower revenue. Lower medical spending and an unexpectedly mild flu season boosted earnings. Company executives do not plan to back off requests for higher premiums where they believe them to be necessary, however. Dollar figures on revenue and income are given in millions.

Revenue Net income Earnings per share
2Q09 2Q10 (change) 2Q09 2Q10 2Q09 2Q10 (change)
Aetna $8,671 $8,546 (-1%) $347 $491 $0.77 $1.14 (48%)

Cigna $4,488 $5,353 (19%) $435 $295 $1.58 $1.06 (-33%)

Coventry $3,537 $2,868 (-19%) $18 $1 $0.12 $0.01 (-92%)

Health Net$4,014 $3,442 (-14%) $40 $45 $0.38 $0.45 (18%)

Humana $7,899 $8,653 (10%) $282 $340 $1.67 $2.00 (20%)

United $21,655 $23,264 (7%) $859 $1,123 $0.73 $0.99 (37%)

WellPoint $15,413 $14,457(-6%) $694 $722 $1.43 $1.71 (20%)

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Coventry takes hit from class-action lawsuit
Coventry Health Care reported steeply rising operating profits for the second quarter of the year, but its earnings were cut to a penny per share due to a court decision in a class-action lawsuit brought by four Louisiana physicians, among others. The Louisiana 3rd Circuit Court of Appeals ordered the company to pay plaintiff health care professionals and hospitals $278 million, representing fines, plus interest.

"We are still working hard and pursuing all avenues of appeal for the Louisiana court decision, which we believe is not supported by either the law or the facts," Coventry CEO and Chair Allen Wise said during a second-quarter earnings conference call with investment analysts July 30.

In 2008, physicians, chiropractors and hospitals sued Coventry subsidiary First Health Group, which operates a workers' compensation rental preferred providers organization. Rental PPOs are referred to as "silent PPOs" in which employers or health plans pay for access to network discounts without clearly disclosing that they are doing so.

In the First Health Group case, defendants included some self-insured employers and some health plans that were accessing the First Health workers' compensation network. Louisiana workers' compensation care is supposed to be paid under a fee schedule set by the state.

The plaintiffs alleged that they were not properly notified that payers were accessing the First Health network discount rates rather than paying according to the state's fee schedule. Louisiana state law requires notification of rental network arrangements.

The case has been taken through state and federal courts, and the remaining disputes center on which is the proper venue and whether the state court's summary judgment should stand.

The Louisiana State Medical Society filed an amicus brief for the plaintiffs with the state Supreme Court on Aug. 2, asking it to reaffirm the lower court finding that payers in Louisiana are not allowed to access network discounts for workers' compensation cases and must pay according to the state's fee schedule.

While appeals work their way through the court system, however, Coventry must account for the settlement they have been ordered to pay. The company recorded the $278 million charge in their second-quarter earnings statements.

Here we go AGAIN

2010-07-28T09:25:00.000-07:00

I couldn't resist posting this information regarding Blue Cross and Blue Shield "NOT FOR PROFIT" health insurance companies. This is my first post since March 23 when President Obama signed the health care reform bill.

BCBS Plans Increased $4.5 Billion Since 2001:

An analysis by Consumers Union found that non-profit
Blue Cross Blue Shield (BCBS) health plans have collected billions in
surplus over the past decade while raising health care premiums. The report
notes that BCBS plans in 10 states (Alabama, Arizona, Massachusetts,
Michigan, New York, North Carolina, Oregon, Pennsylvania, Tennessee, and
Wyoming) held a collective $9.1 billion in surplus funds in 2009, or $855
per-member per-year. In 2001, those plans held $4.6 billion collectively, or
$395 per-member per-year. The report offers policy recommendations to
control and reduce insurer surpluses, including advising states to implement
minimum and maximum surplus ranges and forcing insurers to spend excessive
funds on state-prescribed expenses (Kaiser Health News, 7/22).

Health Care NOW is the Law of the Land

2010-03-23T09:22:00.000-07:00

While driving to work this morning I listened to the health care reform bill signing ceremony taking place in the East Room of the White House. I couldn't help but reflect back to last August when I decided to write this blog. Initially writing the blog was an outlet for my frustration in fighting with insurance companies on behalf of our practice and on behalf of patients requiring health care. Overtime, writing this blog became a forum of legitimate debate, expression of concern for the less fortunate people of the United States of America not having access to health care, and whether or not health care should be treated as a commodity like orange juice or building supplies.

I have been privileged to hear from many of you passionately expressing your views or participating in this debate. Because of this blog I have had several interactions with Senators Boxer and Feinstein, and Representatives Sherman,Waxman, and Pelosi from California. I have been very critical of President Obama and the above named legislators for their inaction and unwillingness to stop corporate america from profiteering off the sick and or injured. I have expressed criticism to all of them for allowing the insurance industry, the medical device industry, and the pharmaceutical industry to drive health care and for taking their campaign contributions. I have publicly stated my opinion that all of them were more concerned about their re-election than they were about providing real access to health care and fixing our broken health care system.

I have also been very critical of the Senate Bill which did NOT go far enough in ensuring access to quality health care. I felt and still believe that the only solution to our broken health care system is universal health care with options for additional coverage (hybrid system). I felt and still believe that aspiring medical students should be educated and trained by our government in exchange for a minimum six year commitment to public health service with reasonable salary after they complete their residency and or fellowship training. I felt and still believe that corporations should NOT be part of the basic health care equation.

Frankly, I do not like this bill because the true beneficiary of this law is the insurance industry who now has over 30 million new customers without significant limitations on pricing. Anthem Blue Cross generated a $4.7 billion profit in the last quarter of 2009. At the same time letters were sent to individual policy holders in California informing them of up to 39% increase in their insurance premiums. Two weeks ago, the Dept of Insurance in California announced their findings of an investigation that Anthem Blue Cross committed 700 insurance violations. Each violation carries a $10,000 fine. This fine will be paid for by policy holders and the constant denial or delay of claims. Blue Cross doesn't care if they violate the rules because they will never pay fines from their profits. In other words, the Health Care Reform Bill signed today by President Obama will not stop the insurance industry from delaying payment or denying claims, raising insurance premiums, violating claims rules, or passing costs from their own negligence onto policy holders and health care providers.

That being said, the law that President Obama signed today is historic in that access to quality health care will now be available to tens of millions of people, who without this law, would go untreated. The law also provides that insurance companies may not deny coverage for people with pre existing conditions and they may not terminate coverage for sick or injured policy holders. Children up to age 26 will be allowed coverage under their parents policy. These are all good things.

As with all health care plans, the young and healthy support the elderly and the ill. Mandatory insurance for all Americans will help cover the costs of pre existing conditions. It won't solve all the economic impact of the legislation, but it will help. Opposition to the bill continues to deny this fact. The fear mongering promulgated by the opposition is a cover for the attitude of caring only about oneself and the continued profiteering off of sick people. As the new law infiltrates our society, the fear will subside when people come to terms with the reality of how little they will be personally effected (unless they don't have health care coverage or earn over $250,000 each year). This bill is NOT socialism. This bill does not take away our personal freedoms. This bill only makes it possible for people to get health care.

I agree with the President that this is a beginning. Concerns such as tort reform, education and training of health care providers, limiting profiteering off the sick or injured by the insurance industry, pharmaceutical industry, and medical device industry, and eliminating waste in providing health care MUST be continuously evaluated. Access to health care and solutions to these concerns will go a long way in FIXING OUR BROKEN HEALTH CARE SYSTEM.

Since Health Care NOW is the law of the land, this will be my last post on HEALTH CARE NOW. It has been a privilege to share my thoughts, concerns, and hopes with you all. I wish you good health.

House Amends Health Care Now only hours after passage

2010-03-21T21:43:00.000-07:00

March 21, 2010 — It seemed like an anticlimax to the history that had just been made on the floor of the House of Representatives, but it was an anticlimax that mattered a lot politically to healthcare reformers in Washington, DC.

At roughly 10:45 pm EST, the House approved a Senate bill in a 219 to 212 vote that overhauls the nation's health system and extends insurance coverage to millions more Americans. Less than an hour later, the House amended that measure in a 220 to 211 vote to incorporate key changes sought by its own leadership as well as President Barack Obama.

The revisions to the Senate legislation appear in a budget reconciliation bill that lawmakers use to change revenue and spending lines in the federal budget. Casting those changes in the form of a reconciliation bill is important to congressional Democrats, because such a bill cannot be filibustered in the Senate, where Democrats lack the 60 votes needed to override a filibuster. The Senate is expected to vote on the reconciliation bill later this week to wrap up months of congressional debate on transforming one sixth of the nation's economy.

The Senate healthcare reform legislation that the House passed and then amended would, among other things, require most Americans to obtain health insurance, help needy individuals and families buy coverage through government-operated insurance "exchanges," prevent private insurers from denying someone a policy based on preexisting conditions, and increase Medicaid enrollment by almost 50%.

Amendments Include Medicaid Pay Raise for Primary-Care Physicians

The amendments approved today do not alter the basic framework of the Senate healthcare reform bill, but they do introduce significant embellishments, some key to the measure's passage. The reconciliation bill would:

Add 16 million additional Americans to the Medicaid program compared with 15 million under the Senate plan, and raise Medicaid reimbursement rates to Medicare levels for general internists, family physicians, and pediatricians in 2013 and 2014.
Eliminate a special deal for Nebraska that would have exempted it from funding its share of an expanded state Medicaid program, and instead beef up federal Medicaid funding for all states.
Eventually close the "doughnut hole" in the Medicare Part D prescription drug plan, a coverage gap that forces Medicare recipients to bear the full cost of medications.
Make steeper cuts in payments to private Medicare Advantage plans.
Levy a 3.8% Medicare Part A (hospital insurance) tax on unearned income for individuals who earn more than $200,000 ($250,000 for married couples). This comes on top of a 0.9% increase in the Medicare Part A tax on earned income for these individuals and couples under the Senate bill.
Delay the effective date of an excise tax on high-cost insurance plans from 2013 to 2018, and increase dollar thresholds for insurance costs that are subject to the tax.
Offer more generous subsidies to individuals and families purchasing required insurance coverage.
When the reconciliation amendments are incorporated, the Senate bill translates into health insurance coverage for 32 million additional Americans over 10 years at a cost of $938 billion while reducing the federal deficit by $143 billion during that period, according to the Congressional Budget Office.

While the reconciliation bill must now receive Senate approval before the amendments take effect, the Senate bill itself — now approved by the House — will go to President Obama for his signature, according to a game plan for today's votes published on the Web site of House Majority Leader Steny Hoyer (D-MD).

[CLOSE WINDOW]
Authors and Disclosures
Journalist
Robert Lowes
Freelance writer, St. Louis, Missouri

Disclosure: Robert L. Lowes has disclosed no relevant financial relationships.

Congress Passes HEALTH CARE NOW

2010-03-21T21:22:00.000-07:00

March 21, 2010 — The great healthcare reform battle of 2009 and 2010, for the most part, is over.

Congressional Democrats today finally passed their bill.

The only thing it needs now is the signature of President Barack Obama to become the law of the land.

In a 219 to 212 vote, the House today approved a bill enacted by the Senate last December that represents the most sweeping government initiative in healthcare since the creation of Medicare and Medicaid in 1965.

Most notably, the legislation will require most Americans to acquire health insurance, help cash-strapped individuals and families purchase it through government-operated insurance marketplaces called exchanges, increase Medicaid enrollment by almost 50%, and impose regulations on private insurers that would prevent them from denying someone coverage based on preexisting conditions.

After the historic vote, the House is expected to turn today to a budget reconciliation bill that would amend the now-approved Senate bill more to the House's and the president's liking. Taken together with this reconciliation bill, the Senate reform package would extend insurance coverage to 32 million more Americans over 10 years at a cost of $938 billion, although it would reduce the federal deficit during that period by $143 billion, according to the latest estimates of the Congressional Budget Office (a few days ago, the CBO had released slightly different dollar amounts).

If approved by the House, the budget reconciliation bill will go before the Senate, where Senate Majority Leader Harry Reid (D-NV) says he has the minimum 51 votes required to pass it. Reconciliation bills — which adjust revenue and spending lines in the federal budget — cannot be filibustered in the Senate. It takes 60 votes in the Senate to override the endless speeches and procedural motions that characterize a filibuster and force a vote on legislation. Republican Senators, who unanimously opposed the reform bill approved by their chamber last year, command 41 votes.

Today's House Vote Makes History in More Ways Than One

In addition to dramatically reshaping the American healthcare system — which accounts for one sixth of the nation's economy — the legislation passed by the House today was historic for other reasons. For the first time, the American Medical Association supported a plan for government-orchestrated healthcare reform after having denounced earlier proposals, including legislation creating Medicare and Medicaid, as dangerous experiments in "socialized medicine." Other major medical societies that backed today's bill were the American College of Physicians and the American Academy of Pediatrics.

The fear of federalization still resonated, though, among Republican politicians who formed a thick stone wall against the legislation. Their arguments against what they called a government takeover of medicine at times reached rhetorical fever pitches that will be remembered for years.

Sarah Palin, the former governor of Alaska and the Republican vice presidental candidate last year, warned that under the Democrats' reform plan, bureaucratic "death panels" would deny care to the disabled and elderly in the name of cost-saving. Even though the likes of the AARP called these claims unfounded, the debate about complex healthcare policy soon featured the catch-phrase "pulling the plug on granny."

At the same time, the new Tea Party movement entered the fray, holding rallies, flooding congressional townhall meetings, and wavings signs with messages such as "Save Granny. Defeat Obamacare" and "Get Government Out of Our Lives." Such protesters showed up today in force in Washington, DC, as the House casts its vote.

Fiery denunciations of reform legislation also resounded inside the Capitol building up until the time of the vote.

"My colleagues are celebrating the birth of a great new entitlement program," said Rep. Marsha Blackburn (R-TN). "Only they see dependency on the federal government and the death of freedom as a cause for celebration. Freedom dies a little bit today."

Last-Minute Promise of Executive Order Against Abortion Funding Secured Key Votes

One obstacle to House Democrats rounding up enough votes for victory was the issue of federal funding of abortions in an overhauled healthcare system.

When House Democrats crafted and passed their own reform bill last year, they included language that would prohibit any woman receiving an insurance premium subsidy from purchasing a health plan that covered an abortion other than a federally sanctioned one to save the life of the woman or in cases of rape and incest. The Senate bill contains a complicated anti-abortion restriction that resembles the House version in intent, but Democratic reform advocates in the House like Rep. Bart Stupak (D-MI) who are also abortion opponents said the Senate language was not strong enough for them to support the bill in good conscience.

Earlier today, President Obama convinced Rep. Stupak and his coalition of like-minded Democrats to change their votes to "Yea" by promising to issue an executive order that would ensure no abortions would be federally funded under the reform bill before the House on Sunday. President Obama released the text of the order and said he would sign it as soon as the House passed the bill.

It was good enough for Rep. Stupak.

"We've been able to come to an agreement to protect the sanctity of life in healthcare reform," Rep. Stupak said Sunday.

Two Medical Societies Applaud Reform Bill, But Say More Legislative Work Remains

In a press release issued tonight, American Medical Association President J. James Rohack, MD, said that by extending health insurance to millions more Americans, the bill passed by the House "will help patients and the physicians who care for them."

"Every day physicians see the devastating effect being uninsured has on the health of our patients," Dr. Rohack said. "Physicians dedicate their lives to helping patients, and we have an historic opportunity now to do just that."

Similarly, Lori Heim, MD, the president of the American Academy of Family Physicians, hailed the bill's passage in a written statement. "As a result of today's vote, Americans can look forward to health security because they soon will have the chance to buy health insurance that meets their needs without emptying their bank accounts," Dr. Heim stated.

Both Dr. Heim and Dr. Rohack said that their societies will continue to work with Congress on what they see as the unfinished business of healthcare reform, particularly medical liability reform and a permanent solution to the problematic formula for setting Medicare reimbursement for physicians, which calls for a 21.2% pay cut this year.

[CLOSE WINDOW]
Authors and Disclosures
Journalist
Robert Lowes
Freelance writer, St. Louis, Missouri

Disclosure: Robert L. Lowes has disclosed no relevant financial relationships.

House votes to repeal anti trust exemption for insurance companies

2010-02-25T14:05:00.000-08:00

February 24, 2010 — In a rare display of bipartisan unity, the US House of
Representatives this afternoon passed, by a lopsided vote of 406 to 19,
legislation that would end health insurance companies' 65-year exemption
from a variety of federal antitrust rules.

Supporters of the bill — the Health Insurance Industry Fair Competition Act,
which would repeal portions of the McCarran-Ferguson Act, passed in 1945 —
argue that it will restore competition to the health insurance market, which
surveys have shown has become increasingly dominated in many areas by 1 or 2
insurers.

"It's time for Washington to decide whether we stand with patients or
profiteering, whether we believe in market competition or a collusion
between politicians and insurance companies," said freshman bill cosponsor
Rep. Tom Perriello (D-VA) in the run-up to the vote.

But skeptics, many in the GOP, charge that the repeal will have a negligible
effect on premiums and that it will do little to address the consolidation
issue — in fact, the Federal Trade Commission and the Department of Justice
already have the authority to examine the antitrust implications of health
insurer mergers and acquisitions.

Citing the Congressional Budget Office, which predicted a small effect on
premiums because states already had laws on their books that outlaw
practices that would be prohibited under the bill, including bid rigging and
price fixing, Rep. Lamar Smith (R-TX) argued during floor debate that "some
may wish upon a star, but this bill is a dim bulb."

Still, dim bulb or not, most House Republicans were not inclined to buck the
popular backlash against insurance companies and vote against the bill.
Some Republicans who ended up voting for the bill nevertheless argued during
the procedural portion of the debate for its amendment. Among other things,
they argued for an amendment that would permit insurance companies to share
historical loss data and actuarial services — a provision, they said, that
would be especially beneficial to smaller insurance companies. The
resolution barring amendments prevailed, however, and Republicans such as
Rep. Dan Lungren of California used a portion of their floor time to argue
for what they say would be more effective cost-control legislation — medical
malpractice reform.

The bill will not affect property and casualty insurers, including medical
malpractice carriers, which will maintain their antitrust exemptions.
Action now moves to the Senate, where the measure may need a supermajority
of at least 60 votes to move forward.

Back by popular demand. First Blog post August 8, 2009

2010-02-24T09:37:00.000-08:00

President Obama called for a bipartisan health care summit that begins tomorrow, February 25, 2010. I have heard from several readers of this blog to re-post my first entry. Enjoy AGAIN

Saturday, August 8, 2009
Welcome to Health Care Now. This Blog is dedicated to fixing a very broken health care system in the USA.

There can be no real health care reform without insurance and pharmaceutical industry reform. Health Insurance and Pharmaceutical Companies DO NOT PROVIDE HEALTH CARE. These companies are in busines to make money for their shaeholders and executives. Check this out!

UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)

CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year.

Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)

Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (source)

Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500

WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700

This is just a handful of health insurance executives. None of these people have ever diagnosed or treated any patient in their executive capacity. In fact, they participate in developing company policy that limits health care to their policy holders and in many cases deny health care to their policy holders. Withholding funding for health care is how these obscene salaries are paid.

Remove health insurance companies from the equation and all this money could actually be used to provide health care for those in need.
Posted by Doc at 5:41 AM

Anthem Blue Cross BUSTED in California

2010-02-24T09:25:00.000-08:00

Insurance Commissioner Poizner Announces Hundreds of Legal Violations During an Investigation of Anthem Blue Cross' Practices

Insurer Faces Multimillion Dollar Fine After Review Finds 700 Plus Claims Handling Violations

California Insurance Commissioner Steve Poizner today announced that an investigation of consumer complaints filed against Anthem Blue Cross' claims handling practices has uncovered more than 700 violations of state law.

"When consumers pay their premiums every month, they expect insurance companies to uphold their part of bargain and pay claims quickly, correctly and comply with all other legal requirements," Commissioner Poizner said. "Our investigation has revealed more than 700 instances where Anthem Blue Cross has violated the state's claims handling laws. From a failure to respond when the Department of Insurance requested information to investigate complaints to misrepresenting the facts to consumers, these are serious violations and if they are proven in the enforcement action, Anthem Blue Cross will be held liable for them."

The California Department of Insurance (CDI) investigated consumer complaints filed against Anthem Blue Cross' claims handling practices in 2006 through 2009. This review found more than 700 violations of the law. The maximum penalty for each violation is $10,000, if the action was found to be willful.

Specifically, the market conduct exams found the following violations of law:

Type of Violation
Quantity

Failure to pay claims in 30 days 277 violations
Failure to respond to the CDI in reasonable time so we can investigate complaints 143 violations
Misrepresenting facts or policy provisions to insureds 66 violations
Failure to pay Interest on unreimbursed claims 25 violations
Failure to pay or contest a claim within 30 days 21 violations
Unreasonably low settlement offers 22 violations
Miscellaneous delays and other claims handling violations 178 violations

The official Accusation and Order to Show Cause will be filed with the Office of Administrative Hearing later today. When it is filed, it will be posted on the CDI Web site.

During the last three years, CDI has finished 10 market conduct exams of the top health insurers. Six exams were completed and four are in progress. So far, three of the six completed exams have resulted in enforcement actions and led to groundbreaking agreements with insurers that helped 4,000 consumers regain access to insurance after their coverage was improperly rescinded. They also led to the following actions:

· Anthem Blue Cross: $1 million fine, offer of new insurance for those who had their insurance policies rescinded, reimburse consumers for out-of-pocket expenses and take corrective action

· Blue Shield: Offer of new insurance for those who had their insurance policies rescinded, reimburse consumers for out-of-pocket expenses and take corrective action.

· Health Net: $3.6 million fine, $7.2 million in waived insurance premiums, offer of new insurance for those who had their insurance policies rescinded, reimburse consumers for out-of-pocket expenses and take corrective action.

FINALLY SOME LEADERSHIP

2010-02-23T15:18:00.000-08:00

Obama backs repeal of insurer antitrust exemption

By Patricia Zengerle Patricia Zengerle
WASHINGTON (Reuters) – The Obama administration on Tuesday threw its weight behind a bid to repeal an anti-trust exemption protecting health insurers, keeping the industry in its crosshairs as it prepares to host a bipartisan summit on revamping healthcare.

"Today the president announced the administration's strong support for repealing the anti-trust exemption currently enjoyed by health insurers," White House spokesman Robert Gibbs said at a daily news briefing.

On Thursday, President Barack Obama will host a healthcare summit, the latest step in his uphill battle to break an impasse in Congress over a sweeping overhaul of the $2.5 trillion industry, one of Obama's domestic policy priorities.

"At its core, health reform is all about ensuring that American families and businesses have more choices, benefit from more competition and have greater control over their own healthcare. Repealing this exemption is an important part of that effort," Gibbs said.

Health insurers for about 65 years have been exempt from federal antitrust laws, which are designed to protect consumers from price fixing and other anti-competitive acts.

The insurance industry said the exemption is narrow in scope and warranted and that its repeal would not lower health care costs.

"Health insurance is one of the most regulated industries in America at both the federal and the state levels," said Karen Ignani, president and chief executive of the industry trade group America's Health Insurance Plans.

"The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers, and the federal budget," she said.

Gibbs said he expected the House of Representatives to vote on legislation to revoke the exemption over the next few days. Obama's support was transmitted to Congress as a statement of administration policy.

INSURANCE INDUSTRY IN THE CROSSHAIRS

The Obama administration has stepped up its rhetorical attacks on health insurers as it fights to push through the healthcare overhaul. New regulation of health insurers was a key part of the overhaul plan Obama announced on Monday, and administration officials have pointed repeatedly to a premium increases of up to 39 percent set by WellPoint Inc.'s Anthem Blue Cross unit in California as evidence of the need for a healthcare overhaul.

A number of House Democrats have said repealing the antitrust exemption is a high priority.

"We want to open up competition. This bill is about making sure that anyone in America who wants to offer health insurance will do so in a free and open market," House Democratic Leader Steny Hoyer said.

"I surely hope it will pass with a significant bipartisan vote."

Democrats said revoking the exemption would prevent health insurance price-fixing or other anti-competitive practices, but did not offer evidence of any. The industry said state laws already forbid such practices.

The American Medical Association released a study on Tuesday showing that many U.S. insurance markets are dominated by just one or two insurance companies. In 24 of the 43 states covered in the report, the two largest insurers had a combined market share of 70 percent or more, up from 18 of 42 states in last year's report.

The House version of the healthcare revamp bills that have stalled in Congress included a repeal of the exemption. The Senate version did not. Obama's proposal in general more closely resembled the Senate plan, and did not address the antitrust exemption.

A number of consumer groups support repeal, saying states often lack the resources to effectively regulate insurers.

Unhappy with Insurance Companies? Only in America

2010-02-19T23:05:00.000-08:00

Sebelius Unveils New Report on Requested Premium Increases in States Across
the Country
Report Highlights Requested Rate Hikes in Connecticut, Maine, Michigan,
Oregon, Rhode Island, Washington

U.S. Department of Health and Human Services (HHS) Secretary Kathleen

Sebelius today unveiled a new report, Insurance Companies Prosper, Families
Suffer: Our Broken Health Insurance System. The report highlights health
insurance premium increases in states across the country and comes shortly
after Anthem Blue Cross announced plans to raise rates on its California
customers by as much as 39 percent, even after its parent company took in a
profit of $2.7 billion in the previous quarter. The complete report is
available at www.HealthReform.gov .
“Over the last year, America’s largest insurance companies have requested
premium increases of 56 percent in Michigan, 24 percent in Connecticut, 23
percent in Maine, 20 percent in Oregon, and 16 percent in Rhode Island, to
name just a few states,” said Sebelius. “Premium increases have left
thousands of families that are already struggling during the economic
downturn with an unpleasant choice between fewer benefits, higher premiums,
or having no insurance at all. Hard-working families deserve better.”
The report examines requested insurance premium increases and notes:
* Anthem of Connecticut requested an increase of 24 percent last year,
which was rejected by the state.
* Anthem in Maine had an 18.5 percent premium increase rejected by the
state last year as being “excessive and unfairly discriminatory” – but is
now requesting a 23 percent increase this year.
* In 2009 Blue Cross Blue Shield of Michigan requested approval for
premium increases of 56 percent for plans sold on the individual market.
* Regency Blue Cross Blue Shield of Oregon requested a 20 percent
premium increase.
* UnitedHealth, Tufts and Blue Cross requested 13 to 16 percent rate
increases in Rhode Island.
* Rates for some individual health plans in Washington increased by up
to 40 percent until Washington State imposed stiffer premium regulations.
Health insurance reform will fix our insurance system, help drive down
costs, put consumer power and choice in the hands of the American people,
and ensure all Americans receive the health care services they need. Reform
will:
* Place additional oversight on health insurance companies to ensure
that people get value for the premiums they pay. Insurance companies will
have to report how they spend the premium dollars that they collect from
their customers. If they spend too much on administrative costs and profits,
they will have to give some of that money back to their customers. Insurance
companies will also have to provide public justification for premium
increases. Consumers can use this information to help decide whether they
want to purchase a particular plan. And if insurance companies are not able
to justify their premium increases, they could be barred from participating
in the health insurance exchanges.
* End Arbitrary Limits Placed on Coverage by Insurance Companies.
Under health insurance reform, families will no longer face lifetime limits
to their benefits, nor will coverage be denied or watered down based on
medical history. As a result, health insurance will provide real protection
from high health care costs.
* End Insurance Company Discrimination. Health insurance reform will
prevent any insurance company from denying coverage based on underlying
health status, including genetic information. It will end insurance
discrimination that charges families more if a family member has or had any
illness, and limit differences in premiums based on age.
* Create Competition Among Insurers with a Health Insurance Exchange.
Health insurance reform creates an “exchange” or marketplace for insurance
competition that will drive down premium prices for Americans. The health
insurance exchange will bring families and plans together into one organized
marketplace so families can compare prices and health plans in order to
decide which quality, affordable option is right for them. Health insurance
reform will guarantee every American a choice of health coverage, even if
someone loses a job, switches jobs, moves, or gets sick.
* Ensure Value in Our Health Care System. By rewarding high-quality
and efficient care, encouraging care coordination, and reducing medical
errors, health reform will slow the growth in health care costs and ensure
value for every health care dollar spent.
* Lower Premiums. The Congressional Budget Office estimates that
reform will streamline administrative costs of insurance companies and bring
more people into the insurance market, lowering premiums of a comparable
plan in the individual market by 14 to 20 percent. That means more money in
the pockets of American families, and the security of having high-quality
coverage.
“Premium hikes in California and across the country are a wakeup call,”
added Sebelius. “It’s time for Congress to pass reform and hand control over
health care decisions back to American families and their doctors.”

$4 Billion Quarterly Profit NOT GOOD ENOUGH FOR BLUE CROSS

2010-02-19T11:54:00.000-08:00

I have not posted in two weeks because I have not fully recovered from reading that Blue Cross generated a fourth quarter FOUR BILLION PROFIT while sending out notices to California individual policy holders that their premiums would be increased up to 39%. I received a message this morning from a follower of this Blog asking why I haven't posted recently. I'm still trying to pull the Blue Cross sword out of my .........

NEW YORK TIMES Editorial
The Lesson of Anthem Blue Cross
Published: February 18, 2010

Clients were understandably furious when Anthem Blue Cross, the largest for-profit health insurer in California, announced huge rate increases for people who buy their own insurance: an average increase of 25 percent, and a 35 percent to 39 percent rise for a quarter of the purchasers. The move also provided a textbook example of why the nation badly needs comprehensive health care reforms.

The reform bills stalled in Congress would put a brake on such out-of-scale premium increases by broadening the pools of insured people to keep average premiums low, by setting up competitive insurance exchanges and by starting to rein in the cost of medical care that is driving up premiums everywhere.
Private insurers in several other states also have sought and won double-digit increases for policies sold to individuals. In one striking case, a Blue Cross Blue Shield plan in Michigan sought a 56 percent average increase in premiums for individually bought policies but settled for 22 percent in a compromise with regulators.

If the increases go through in California, where regulators have limited powers to control rates, Anthem’s enrollees would have to choose between paying the higher price, moving to lower-cost policies, perhaps with a high deductible, switching to another insurer if they can find one to take them, or dropping coverage entirely.

The nation’s largest health insurers reported substantial profits last year over all, but Anthem claims it lost money on the individual market in California. Its parent company, WellPoint Inc., attributed the need for the huge rate increase to a changing mix of customers as the recession forces many people to cut back on expenses.

The company says that healthier customers, gambling that they won’t need much care, are disproportionately dropping Anthem coverage or choosing not to enroll. The less healthy are staying with Anthem, where their higher medical costs are driving up premiums.

WellPoint will be asked to justify the increases at hearings in Congress and the State Legislature. California’s insurance commissioner is investigating whether Anthem will be meeting regulations to spend at least 70 percent of its premium revenues on claims.

It’s hard to know which conclusion would be worse: that Anthem is trying to fleece its individual customers or that Anthem’s rates are actuarially justified by its increasingly unhealthy enrollment pool.

The salient point is that the reform bills pending in Congress could almost certainly prevent this problem from developing. The bills would require everyone to buy health insurance (many with government subsidies). That would create large pools to spread the risk over both healthy and sick enrollees and keep average premiums low. On new insurance exchanges, people who buy their own insurance could benefit from group purchasing power and could choose from an array of policies. Competition among insurers on the exchanges is expected to help keep premiums down.

How about the Republicans’ health care proposals?

They would only address a small part of the Anthem problem. The Republicans reject the idea of mandates to spread the cost of care and instead call for ways for people dissatisfied with their insurer to buy cheaper coverage elsewhere. That could help relatively healthy people but would do nothing for the chronically ill or anyone with pre-existing conditions. They would be stuck in their health plans. State high-risk pools for sick people, another Republican solution, almost always have high premiums and would not provide a safe haven from rate increases in private plans.

Unless Congress passes comprehensive reform, we should expect many more Anthems in our future.

NOT DEAD YET

2010-01-29T18:55:00.000-08:00

The California Senate passed a bill to create a single-payor health system, less than a week after a special election in Massachusetts cost Senate Democrats' the 60-vote majority they needed to pass federal health reform legislation.

Although Gov. Arnold Schwarzenegger has promised to veto the California bill, it could signal a change in the health reform debate, as proponents of health reform get frustrated with the national stage and move efforts to the states.

What happens to proposal now? The California Senate passed the bill by 22-14, with all but one Democrat and no Republicans voting for it. It now goes to the state Assembly, which has passed previous California single-payor bills, then to Gov. Schwarzenegger, who vetoed the previous bills. If passed, the bill would authorize $1million to establish a commission to decide how to pay for the system.

How does this relate to national health reform? Democratic State Sen. Mark Leno, the author of the bill, said voters came to dislike Congress' compromise health reform legislation. "Whatever comes out of Washington is much less certain, which only gives greater incentive for leadership coming from state legislators because somehow, some way, health care reform must be addressed," Mr. Leno told the Huffington Post.

What do Californians think? Mr. Leno points to past polls that have shown support for a state-run plan. A new poll by the Public Policy Institute of California finds that 74 percent of Californians believe the state is headed in the wrong direction. This could be interpreted as a call for radical change or anger at current legislators, the people who passed this bill.

What do opponents think? "What a bizarre place I work in," wrote Republican State Sen. Sam Aanestad, an oral surgeon, in the New American. Following the Massachusetts defeat, "Democrats who control the State Legislature in California revived their own universal healthcare bill. Didn't they get the message I did?"

How might other states react? With the prospect of the Congress' health reform bill failing, the health reform debate may now move to the states. Massachusetts has already enacted universal healthcare. Illinois, Oregon and Massachusetts have flirted with single-payor systems in state legislation and referendums, but all have failed so far.

Could it have a polarizing effect? There already is a wide gap between passionate proponents of a single-payor system, such as Physicians for a National Health Program, and opponents of government intervention in healthcare. Positions could harden if the federal health reform bill, which was supposed to bridge the divide, is not passed.

What exactly is a single-payor system? It involves creating a government-run or financed plan open to everyone. It may or may not be linked with elimination of private insurance and government-run health facilities. Canada and several European nations have various kinds of single-payor systems.

How would it affect physicians and hospitals? "I cannot support an under-funded program that would leave patients with far fewer options for care than they have today," Dr. Aanestad stated. The concerns are that a single-payor system could drive reimbursements down to Medicare levels and lead to waiting lines for certain services, as occurs in the Canadian system. Some U.S. physicians are already bailing out of Medicare, the U.S. single-payor system for the elderly, because it pays too little. But others argue that a single payor would be a boon for healthcare, providing a massive infusion of new paying patients and improving health status by detecting diseases earlier.

Could it reduce insurance premiums? Paul Krugman, a New York Times columnist who supports a single-payor system, has argued the arrangement could curb premium growth by eliminating the costs of insurer-middlemen and by extending coverage to healthy people who are less costly to the system.

Would it add to California's budget deficit? The state faces a $20 billion deficit. The California Legislative Analysts Office said the single-payer proposal would cost $200 billion, or more than $5,000 in new taxes for every Californian. But Sen. Leno argued that Californians already pay $200 billion for their healthcare through premiums and other funding. He said the system could be funded through a payroll tax, existing state and federal funding and increased efficiencies by eliminating the insurer-middleman.

Possible removal of anti trust exemption for insurance industry

2010-01-28T09:44:00.001-08:00

Last night before President Obama's State of the Union Address, I heard a newscaster say that the Speaker of the House was considering giving up the massive health care reform bill in favor of pursuing passage of small, separate pieces of the larger reform agenda. As an example, she pointed to the anti trust exemption enjoyed by the insurance industry for several decades.

If this is accurate information, WE THE PEOPLE will be the beneficiaries. This small reform item is very large in the overall "big picture" because insurance companies will no longer be able to fix prices (both insurance policies and reimbursement to providers) and will have to act independently. This will lead to competition amongst the insurance companies for policy holders and provider contractors resulting in driving prices down while increasing access to more providers since the health insurance companies will no longer desire to exclude providers from their networks.

Contact your Senators and Representatives and let them know you want the anti trust exemption that protects the insurance industry REMOVED. We all can help accomplish Health Care Now by letting our elected officials know how we feel about the unfair advantage insurance companies have in the market place, and their abusive tactics towards policy holders and providers.

US Supreme Court legalizes prostitution.

2010-01-21T13:20:00.000-08:00

The US Supreme Court has validated what I have been screaming about in this blog since August. The court's decision this morning allows unlimited corporation campaign contributions. The worst part is WE THE PEOPLE ARE PAYING FOR IT. Every time you pick up a prescription, every time you make a bank deposit, every time you put gas in your car or heat your home, every time you eat a piece of meat or drink a glass of milk, every time you make an insurance premium payment, you are paying for lobbyists to keep corporate america powerful and protected by the US Government.

Every legislator and elected executive at every level receives campaign contributions from corporations. After today's Supreme Court decision, politicians can receive unlimited funds from the highest bidder. Prostitution is now overtly LEGAL. Our purchases add to the corpus of $$$ available to buy politicians. It has come to a point that the only solution may be revolution.

We are engaged in two wars. Our our economy is NOT improving. The jobless rate continues to increase. The homeless rate continues to increase. Financial assistance to people suffering from international disasters (earthquakes) gets priority over help for our own homeless and jobless. NO HEALTHCARE REFORM. Insurance industry protected by anti trust exemption. Gutless Presidential leadership and worthless congressional leadership. And today the US Supreme Court decision to allow corporations to buy our politicians with unlimited campaign contributions. I doubt very seriously that our founding fathers had unlimited campaign contributions in mind when constructing our Constitution.

South of France is looking very good these days.

Real Health Care Reform NO longer possible

2010-01-20T16:49:00.000-08:00

Neither the House or Senate bill provide REAL reform. Real reform would
require:

1) removal of the anti trust exemption for insurance companies

2) limits on policy pricing in exchange for up to 45,000,000 new customers

3) No refusal of insurance for pre existing conditions

4) No cancellation of policies when a policy holder contracts a
catastrophic illness

5) A public option to ensure competition that will drive health care
costs DOWN

Pretty simple and doesn't require 2000 pages of unnecessary language!

I was a staunch supporter of Obama and health care reform until Obama showed he has no balls and the congress showed they are worthless. I hope they all get replaced in their next election. Obama is the biggest political disappointment since I started to vote over 42 years ago.

Democrats Negotiate Healthcare Legislation, Plan to Submit for Cost Estimate Early Next Week

2010-01-14T11:15:00.000-08:00

Written by Lindsey Dunn | January 14, 2010

More Key Congressional Democrats, along with Pres. Obama, held a nearly day-long session yesterday to negotiate a joint healthcare reform legislation package with the aim of submitting a final plan to the Congressional Budget Office early next week. Negotiations are expected to continue today.

In a joint statement, Pres. Obama, House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) said the group had made "significant progress in bridging the remaining gaps between the two health insurance reform bills."

Key issues within the plan that continue to require debate, as outlined by the Washington Post and the Wall Street Journal include:

Value of subsidies provided to low-to-middle-income Americans to obtain coverage (Both the House and Senate bills contain provisions that would provide subsidies to Americans with incomes up to 400 percent of the federal poverty level, but the value of such subsidies is unclear);
Insurance plan value with which to begin "Cadillac" tax on high-cost health plans (The House bill would begin taxing on plans that are valued at or above $23,000 for a family, though the Washington Post report this may be increased to $25,000 after negotiations);
Structure of a mandate that would require employers to offer insurance coverage to employees (House bill currently requires employers with payrolls greater than $500,000to offer coverage, while the Senate bill would impose a penalty on employers with more than 50 employees that do not offer coverage);
Whether an insurance exchange would be run by states or the federal government (Both the House and Senate bills would offer exchanges for Americans that do not qualify for coverage through an employer or a public program); and
Overall funding for the bill (Both House and Senate bills offer slightly differing proposals for funding, including taxes on high-income Americans, taxes on high-cost health plans, taxes on medical devices, reductions in Medicare expenditure growth and annual fees for health insurance companies).
Although the kinks are still being worked out, current estimates place the cost of the legislation, which would extend healthcare coverage to 36 million Americans at approximately $900 billion.

CBO analysis is expected to take at least a week, making it unlikely that the bill would be pushed through both the House and Senate and on to Pres. Obama before his State of the Union address planned for early February, according to the Washington Post.

Republicans vow they will continue work to block the legislation. House Minority Leader Johan Boehner (R-Ohio) told fellow Republicans that they could still "beat the bill," according to the Washington Post.

Read the Washington Post's report on healthcare reform legislation.

Read the Wall Street Journal's report on healthcare reform legislation.

Senate Health Care Bill must be DEFEATED

2009-12-23T16:50:00.000-08:00

Nation’s Largest RN Organization Says Healthcare Bill Cedes Too Much to Insurance Industry
By National Nurses United

December 21, 2009

The 150,000 member National Nurses United, the nation’s largest union and professional organization of registered nurses in the U.S., today criticized the healthcare bill now advancing in the U.S. Senate saying it is deeply flawed and grants too much power to the giant insurers.

“It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the healthcare crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry,” said NNU co-president Karen Higgins, RN.

NNU Co-president Deborah Burger, RN challenged arguments of legislation proponents that the bill should still be passed because of expanded coverage, new regulations on insurers, and the hope that it will be improved in the House-Senate conference committee or future years.

“Those wishful statements ignore the reality that much of the expanded coverage is based on forced purchase of private insurance without effective controls on industry pricing practices or real competition and gaping loopholes in the insurance reforms,” said Burger.

Further, said NNU Co-president Jean Ross, RN, “the bill seems more likely to be eroded, not improved, in future years due to the unchecked influence of the healthcare industry lobbyists and the lessons of this year in which all the compromises have been made to the right.”

“Sadly, we have ended up with legislation that fails to meet the test of true healthcare reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the chokehold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations,” Higgins said.

NNU cited ten significant problems in the legislation, noting many of the same flaws also exist in the House version and are likely to remain in the bill that emerges from the House-Senate reconciliation process:

The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.

No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition.

An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.

The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees.

Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include:

Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
Insurers are permitted to sell policies “across state lines”, exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
Insurers may continue to rescind policies for “fraud or intentional misrepresentation” – the main pretext insurance companies now use to cancel coverage.

Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California’s largest insurers have rejected more than one-fifth of all claims since 2002.

Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs.

New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn’t want.

Reduced reproductive rights for women.

No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right.
“Desperation to pass a bill, regardless of its flaws, has made the White House and Congress subject to the worst political extortion and new, crippling concessions every day,” Burger said.

“NNU and nurses will continue to work with the thousands of grassroots activists across the nation to campaign for the best reform, which would be to expand Medicare to cover everyone, the same type of system working more effectively in every other industrial country. The day of that reform will come,” said Ross.

United Health Care profits soar 155 percent on Medicare

2009-12-21T11:49:00.000-08:00

United Health Care profits soar 155 percent on Medicare plans
By Jerry Mazza
Online Journal Associate Editor

Sep 25, 2009
United Health Care’s 155 percent profits on Medicare plans must be a company record, especially in a down economy, and an embarrassing fact, particularly as the concervatives on the Senate Finance Committee fight to preserve the present payment structure of United Health Care and its fellow private insurance companies.

Private insurance plans in Medicare cost up to 19 percent more than it would cost to care for the same people in the public Medicare program. But then, we know whose pockets the Republicans and Blue Dog Democrats are really stuffing.

And never mind, as the Medicare Rights Center points out, “Private plans came into the Medicare program with the claims that they could save taxpayers money.” Right and I’ve got a bridge in Brooklyn I can let you have for cheap. The fact is, “they [the Private Plans] cost between 12 percent and 19 percent more per person than the public Medicare program, amounting to $5 billion per year in over-fattened costs to taxpayers.”

I guess this must be the advantage in the Medicare Advantage plans, only it’s for United Health Care and friends not the USA and its taxpayers. In fact, as Families USA reported, “Overpayments to Medicare Advantage plans and those regional PPOs could easily cost more than $60 billion over the next 10 years . . .” Hey, piece of cake, right?

And as Families USA noted, “As part of the 2003 Medicare Modernization Act, Congress has substantially increased payments to Medicare Advantage plans. They’re overpaid in comparison to traditional Medicare.” Modernization, you understand, means privatization here, thanks to George Bush and now Barack Obama and Congress, God love them if she can.

For instance, in 2005, Medicare overpaid private plans by at least 7 percent per beneficiary. And you, Mr. and Mrs. Taxpayer, lost $2.7 billion in 2005 to private Medicare Advantage plans and their parent insurance companies. Then, in 2006, under a new payment formula [woo, woo], overpayments to plans were 11 percent per beneficiary (that is, after accounting for health care status). And now in 2009, up in the 19 percent range. Nothing like HMOs and PPOs saving us money.

See, they keep telling innocent seniors that they will suffer (even more) if they lose their Medicare Advantage plans. Don’t believe it, folks. Medicare Advantage plans can hurt people with Medicare. Two studies found that people could end up actually paying higher out-of-pocket costs in a private plan than in straight Medicare, or in one private plan over another. I mean, the minute you let those dogs in, they’re gonna bite you, not protect you.

A study by MedPac found that a share of Medicare private health plans have high cost-sharing for “nondiscretionary” services such as chemotherapy. Like say, looking at some of the costs for a 70-yer old male with advanced colon cancer, the study showed out-of-pocket charges of $7,100 for one plan, $6,500 for a second plan and $1,900 for a third plane. You’re rolling the dice for your life with all this razzle dazzle. So, buyer beware!

Another study, by the nonpartisan [could that be] Commonwealth Fund found that out-of-pocket costs for private health plan members vary widely not only by your plan benefit package but by your health status. The report says that costs for plan members in poor health are actually higher than public Medicare in 19 out of the 88 private Medicare Advantage (MA) plans looked at. “Despite the high payments, relative to fee-for-service [public Medicare] costs, that MA plans receive from Medicare to enrich enrollee benefits, these plans may not always be a good deal for sicker beneficiaries who use more health services.”

A little bit of backstory

Medicare, the federal health insurance program for people over the age of 65 and those with severe disabilities, contracts with private health insurance plans that compete with the public Medicare program for membership. So, you have a choice, and I would recommend staying away from the “Advantages.” You’re somewhat better off with the Medigap programs that simply fill in the holes, like co-pays, yearly deductibles, and allow you to go to whatever doctor you want to.

That said, according to the Kaiser Family foundation, here is a quick look at private plans in Medicare through 2006 . . .

“As the private market for health insurance has evolved, Medicare has been modified so that beneficiaries can elect to get their Medicare benefits through a qualified private plan rather than the traditional fee-for-service Medicare program. Authorized in 1982, the Medicare risk-contracting program provided for enrollment in health maintenance organizations (HMOs).

“In 1997, Congress expanded private plan authority to include preferred provider organizations (PPOs), provider-sponsored organizations (PSOs), and private fee-for-service (PFFS) plans as the Medicare risk-contracting program was absorbed into Medicare+Choice (M+C). The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) replaced M+C with the Medicare Advantage (MA) program in 2004, raising payment rates and making other changes in anticipation of the Medicare drug benefit in 2006.”

So you can see for yourself how the cats were let in the door under the guise of “modernization,” “improvement” and so on. Take note that the name changes for the private health plans went through as they contracted with Medicare. “Medicare risk-contracting program,” not so appetizing, became “Medicare+Choice,” tastier, to “Medicare Advantage.” Delicious! Now gimme some of that. I want my advantage.

Yeah, well, it’s time to put back the advantage where it belongs, in the hands of the folks with Medicare, not in the coffers of the fat cat insurance companies. Let Medicare plans compete if they want, say, even if we descend to a public option if or if . . . who knows . . . to rampant socialism . . . and a Single-Payer (America-Care as one writer proposed), if they dare. Yea! Though be prepared for some kind of goulash, with a little bit of this and little bit of that and a lot of it all for the private sector.

Jerry Mazza is a freelance writer living in New York City. Reach him at gvmaz@verizon.net. His new book, “State Of Shock: Poems from 9/11 on” is available at www.jerrymazza.com, Amazon or Barnesandnoble.com.

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Rob from the POOR and Give to the RICH

2009-12-17T06:54:00.000-08:00

View this video and then call or write your Senator IMMEDIATELY. The current health care bill in the Senate literally robs from the poor and gives to the rich.

http://www.msnbc.msn.com/id/3036677/#34455431

Screwed AGAIN

2009-12-16T19:16:00.001-08:00

Our President has done it again. In his lobbying the Senate for the passage of ANY watered down health care reform bill, the section allowing the importing of pharmaceuticals at much lower prices than what we currently pay has been stricken from the bill. Coupled with the removal of a public option to create competition for policy holders, corporate america is the big winner while WE THE PEOPLE are SCREWED AGAIN.

What a major disappointment. President Obama's ratings have dipped to 50% approval and declining in less than a year. This is reflective of how he has abandoned the people who got him elected. He raised hope during his campaign and as soon as he was elected he has caved on every important issue including bailing out wall street and the banks, the escalation of the War in Afghanistan, and Health Care Reform. He promised to end the wars and create REAL HEALTH CARE REFORM. He promised to create jobs. What we will end up with is a health care bill that benefits the insurance industry and pharmaceutical industry. more of our kids dying, while our leaders line their pockets with campaign contributions in exchange for protection.

This is all about the economics of politics. Our elected representatives are all supported by corporate america, and are only interested in maintaining their political power. The deals to protect Big Pharma and the Insurance Industry in exchange for political support is the DC norm. Line our pockets and SCREW THE PEOPLE--this is the real party line. This is the Executive and Legislative branches of our government. Only in politics is bribery and corruption legal.

Public Option is Dead

2009-12-10T11:43:00.000-08:00

The public health insurance option died on Thursday, December 10, 2009, after a months-long battle with Senate parliamentary procedure. The time of death was recorded as 11:12 a.m. Eastern Standard Time.

Thank you United States Senate, House of Representatives, and President Obama for allowing special interest such as the insuance industry, pharmaceutical industry, and medical device industry to continue to control health care. These companies continue to excessively profit off the sick and injured. You couldn't have done anything worse for the health and well being of all Americans.

MAJOR Disappointment for Health Care NOW

2009-12-08T20:03:00.000-08:00

Harry Hamburg, AP
Senate Majority Leader Harry Reid, D-Nev., said Tuesday a "broad agreement" had been reached on the public health care option. He would not provide details, but several officials said the government-run option is being dropped.

In place of a government-run plan, originally designed as a way of forcing competition on private industry, officials said the Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage. Additionally, the tentative deal calls for Medicare to be opened to uninsured Americans beginning at age 55, a significant expansion of the large government health care program that currently serves the 65-and-over population.

The officials who described the details did so on condition of anonymity, saying they were not authorized to discuss them publicly. Despite their reluctance, some senators had talked openly earlier in the day about the progress of the negotiations.
The developments followed a vote on the Senate floor earlier in the day in which abortion opponents failed to inject tougher restrictions into sweeping health care bill, and Democratic leaders labored to make sure fallout from the issue didn't hamper the drive to enact legislation. The vote was 54-45.

Aetna Forcing 600,000-Plus To Lose Coverage In Effort To Raise Profits

2009-12-04T14:55:00.000-08:00

From the Huffington Post

Health insurance giant Aetna is planning to force up to 650,000 clients to
drop their coverage next year as it seeks to raise additional revenue to
meet profit expectations.

In a third-quarter earnings conference call in late October, officials at
Aetna announced that in an effort to improve on a less-than-anticipated
profit margin in 2009, they would be raising prices on their consumers in
2010. The insurance giant predicted that the company would subsequently lose
between 300,000 and 350,000 members next year from its national account as
well as another 300,000 from smaller group accounts.

"The pricing we put in place for 2009 turned out to not really be what we
needed to achieve the results and margins that we had historically been
delivering," said chairman and CEO Ron Williams. "We view 2010 as a
repositioning year, a year that does not fully reflect the earnings
potential of our business. Our pricing actions should have a noticeable
effect beginning in the first quarter of 2010, with additional financial
impact realized during the remaining three quarters of the year."

Aetna's decision to downsize the number of clients in favor of higher
premiums is, as one industry analyst told American Medical News, a "pretty
candid" admission. It also reflects the major concerns offered by health
care reform proponents and supporters of a public option for insurance
coverage, who insist that the private health insurance industry is too
consumed with the bottom line. A government-run plan would operate solely
off its members' premiums.

http://www.huffingtonpost.com/2009/12/04/aetna-forcing-600000-plus_n_380130.html

American Medical News, which first reported the
story, noted that this is not the first time the
insurance giant has cut the rolls in an effort to
boost profit margins. "As chronicled in a 2004
article in Health Affairs by health economist
James C. Robinson, MD, PhD, Aetna completely
overhauled its business between 2000 and 2003,
going from 21 million members in 1999 down to 13
million in 2003, but boosting its profit margin
from about 4% to higher than 7%."

Get Involved! Demand Health Care NOW Senate debate

2009-12-03T10:25:00.000-08:00

The health care bill has hit the Senate.

This week, the Senate began debate on the Patient Protection and Affordable Care Act. The debate in the Senate is expected to be a long and complicated process, carrying on for upwards of three weeks.

During the debate, health care reform opponents will resort to desperate measures to stop this legislation, using stall tactics and other procedural tricks like filibusters. It's up to people like you and me to make sure this bill keeps moving.

For the health and well-being of men, women, and children across the country, we need the Senate to pass this bill as soon as possible. Sign our petition asking Senators across the aisle to come together for all Americans.

Tell them not to filibuster health care reform:

http://www.standupforhealthcare.org/page/s/dontfilibuster

Since you are an important member of the Stand Up For Health Care community, we wanted to keep you up to date on the Patient Protection and Affordable Care Act as it currently stands before the Senate.

Our policy experts have reviewed the bill and have found that among many other improvements, this legislation will lower costs for small businesses and working families. The bill will also lower premiums, providing significant savings for lower- and middle-income Americans. A public option in the bill will provide more choice in coverage. And, most importantly to some, the bill will allow Americans to keep their current insurance if they are happy with it.

We believe the Patient Protection and Affordable Care Act will help millions of Americans—but it can only help us once it’s passed.

Stand up for health care today. Tell the Senate not to stall on health care reform:

http://www.standupforhealthcare.org/page/s/dontfilibuster

AARP Backs Senate Health Care Reform Bill

2009-12-02T16:35:00.000-08:00

AARP backs Democrats in Senate health care fight
By DAVID ESPO, AP

With a Senate showdown looming, the politically potent AARP rode to the rescue of Democrats on Wednesday, supporting $460 billion in Medicare cuts to help pay for landmark health insurance legislation.

As Republicans pressed to restore the cuts, AARP said Democrats merely were recommending elimination of waste and inefficiency within the giant health care program for seniors.

"Most importantly, the legislation does not reduce any guaranteed Medicare benefits," A. Barry Rand, the AARP's CEO, said in a letter to senators.
Republicans, led by Sen. John McCain, said seniors would lose some of their add-on benefits that are part of coverage under private insurance Medicare. "Above all, we must not use Medicare as a piggy bank" to pay for other programs, the Arizona Republican said.

Democrats, sensitive to the charges, rallied behind an alternative proposal by Sen. Michael Bennet, D-Colo., saying the bill would cause no reduction in guaranteed Medicare benefits.

A vote was expected later Wednesday on the issue, one of two that have dominated early debate on health care legislation that President Barack Obama has urged Congress to enact.

Women's health care was the other. The two parties maneuvered for political advantage on that issue, as well, each backing a promise to provide new no-cost preventive procedures such as mammograms.

Overall, the legislation is designed to extend health care to millions who now lack it, prohibit insurance companies from denying coverage on the basis of pre-existing medical conditions and generally slow the rate of growth in medical spending overall.

Most Americans would be required to carry insurance. While employers would not be obliged to provide it, big companies would face penalties if they did not and their workers received federal subsidies to help defray their personal insurance costs.
At its core, the bill would create new marketplaces, called exchanges, where consumers could shop for insurance that met government guidelines. The bill includes hundreds of billions of dollars in federal subsidies to help lower and middle-income individuals and families afford insurance.

The House passed its version of health care legislation last month, and Senate Majority Leader Harry Reid, D-Nev., has vowed to clear a bill through his chamber by Christmas.

The early pace of debate has been exceedingly slow, and Democrats accused Republicans during the day of stalling.

"There's a lot of talk that if we have to be here until Christmas, we'll be here until Christmas," Sen. Tom Harkin, D-Iowa, said after a closed-door Democratic caucus meeting.

That seems unlikely.

Democrats command 60 seats, enough to end any delaying tactics if they are united. So far, they are not, and while debate unfolds on the Senate floor, Reid is working behind the scenes to resolve a small number of controversial issues.

Chief among them is a call by liberals for the government to sell insurance in competition with private industry. The legislation on the floor permits that, subject to approval from individual states. But an unknown number of moderate and conservative Democrats have demanded changes as the price for their support on the legislation.

AARP has played an influential role all year on health care, working with the Obama administration as well as Democratic leaders to help pass legislation.
The organization's Web site claims more than 40 million members in all 50 states, and describes AARP as "a nonprofit, nonpartisan membership organization that helps people 50 and over improve the quality of their lives."

Polls have shown the group enjoys a high degree of trust among seniors, a group that tends to vote in disproportionately high numbers, particularly in midterm elections. As a result, its endorsement is prized by both political parties.

When Republicans held power in Congress, AARP's decision to support a new prescription drug benefit under Medicare was a turning point in the drive to pass legislation.

Democrats were furious at the time. But now, in power, they have worked closely with the organization, and the political lines are reversed.

"Shame on AARP," McCain said earlier in the week as he pressed his case to restore the cuts Democrats wrote into their legislation. Sen. Lamar Alexander, R-Tenn., accused Democrats repeatedly of seeking to cut "Grandma's Medicare" and use the money to finance other programs.

McCain and others recited the proposed cuts in future payments during days of debate, including private-insurance Medicare, payments to hospitals, hospices, home health agencies and others.

But Rand, in his letter, wrote, "AARP believes that savings can be found in Medicare through smart, targeted changes aimed at improving health care delivery, eliminating waste and inefficiency, and aggressively weeding out fraud and abuse."

The biggest cuts are aimed at the Medicare Advantage program, in which private companies provide coverage. Studies show the government pays 14 percent more a year for each beneficiary covered in a private plan, compared with traditional Medicare.
Critics say that money goes into high executive salaries and profits for the firms. But supporters say the plans use the funds to provide extra benefits, sometimes including vision or dental coverage or gym memberships.
—
Associated Press writers Ricardo Alonso-Zaldivar and Erica Werner contributed to this report.

Senate Votes to Bring Health Care Reform Bill to Floor

2009-11-21T22:04:00.000-08:00

Posted: 11/21/09 With no votes to spare, Democratic senators moved health care reform past its first major hurdle Saturday night, with a party-line, 60-to-39 vote to begin consideration of the 2,000-plus page bill that Senate Majority Leader Harry Reid unveiled this week.

The fate of the measure came down to two moderate Democrats -- Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana. Both women had withheld their support for debating the bill until the last hour, but announced in the afternoon that they would vote with Reid -- at least for now.

"My vote today should in no way be construed as an indication of how I might vote as this debate comes to an end," said Senator Landrieu. "After a thorough review, I have decided that there are enough significant reforms and safeguards in this bill to move forward, but more needs to be done."

Senator Lincoln echoed her colleague's skepticism, saying she would vote to move forward with the debate, but stressing that she wants changes to the legislation -- including striking the public option entirely -- before she would consent to vote for it on final passage. "I have concluded that it is more important to begin debate rather than simply dropping the issue and walk away," Lincoln said.

The bill that senators will begin debating after Thanksgiving combines proposals passed by the Senate Finance Committee and the Senate Committee Health, Education, Labor and Pensions Committee (HELP), and is designed to make health insurance more accessible and affordable. The Congressional Budget Office estimates the bill would expand coverage to 94 percent of Americans at a cost of $848 billion over the next 10 years.

In addition to imposing new regulations on insurance companies, the legislation would create health insurance exchanges, which would function as a marketplace of last resort where Americans could choose between private insurance, non-profit cooperative insurance, and a government-run public insurance option. While Democrats differed in their levels of enthusiasm for the bill, Republicans were unanimous in their opposition, describing Reid's proposal as everything from a spending binge to a Ponzi scheme.

Sen. Olympia Snowe of Maine, who voted for the Democrats' bill in the Senate Finance Committee, voted against debating it Saturday night. She objected to many of the the policies in the version of the bill that emerged from the Majority Leader's office, including the public option. Mostly, Snowe was critical of the closed-door, partisan process used by Reid to combine the two committee bills.

Sen. Mike Enzi (R-Wyo.), the top Republican on the Senate HELP Committee and the only accountant in the Senate, warned of the bill's potentially catastrophic effect on the federal budget deficit. "Perhaps the best way to qualify this bill is to say it keeps me up nights," Enzi said, summing it up in one word: "Disaster."

Other Republicans, such as Sen. Orrin Hatch of Utah objected to the bill's abortion provisions, which are weaker than the House-passed bill, as well as the bill's estimated cost of nearly $1 trillion to the taxpayers over the next decade. Missouri Republican Sen. Kit Bond said there were so many objectionable elements to the proposal that his colleagues had a hard time choosing which ones to go after first. "We're like a mosquito in a nudist colony," he said. "We have so many targets to attack in this bill we don't know which one to hit."

Democratic leaders defended their bill, with Reid saying of Sen. Mitch McConnell (R-Ky.), "The facts he is talking about do not exist, except in the minds of people who do not understand this bill." Several Democrats also invoked the late Sen. Ted Kennedy before casting their votes, including Kennedy's close friend Connectucut Sen. Chris Dodd, who said "there is no greater compliment we could give to Ted Kennedy than to pass this bill."

In the minutes before the vote, Sen. Max Baucus, a leader for the Democrats in health care reform, said to his fellow senators, "History is knocking on the door. Let's open it."

House Bill DOES NOT regulate insurance premiums resulting in big gains for corporations.

2009-11-13T10:18:00.000-08:00

From Marcia Angell, MD Harvard University

The Health Care Reform Bill passed by the House enshrines and subsidizes the "takeover" by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn't regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.

What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers -- those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65's will be more likely to go without insurance, even if they have to pay fines. That's OK with the industry, since these would be among their sickest customers. (Shouldn't age be considered a pre-existing condition?)

Insurers also won't have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an "option" at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it's been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.

If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?

First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers -- government and employers -- will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.

But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It's a shell game in which money is moved from one part of our fragmented system to another.

Here is my program for real reform:

Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it's a better program, because it ensures that everyone has access to a uniform package of benefits.

Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.

Recommendation #3: Medicare should monitor doctors' practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.

Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.

Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.

Is the House bill better than nothing? I don't think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we've tried health reform and it didn't work. But the real problem will be that we didn't really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

Is there really any question that HEALTH CARE REFORM is NECESSARY?

2009-11-11T16:52:00.000-08:00

Following is an article published by Associated Press discussing the unethical and immoral behavior of pharmaceutical company Pfizer. The people at Pfizer who conduct bogus research that is then used for marketing their drugs based on the "fudged" results should be criminally prosecuted. As stated in several blog posts, the insurance companies, the pharmaceutical companies, and the medical device companies should all be held accountable for the price fixing, price gauging, and unethical behavior exhibited by these companies executives, researchers, and other employees.

Review: Reporting on Pfizer drug studies fudged

By LINDA A. JOHNSON, Associated Press Writer – 1 min ago
Analysis of a dozen published studies testing possible new uses for a Pfizer
Inc. epilepsy drug found that reporting of the results was often fudged,
indicating the medicine worked better than internal company documents
showed.

According to the report, when a company-funded study's primary finding
wasn't favorable, that result was usually buried and something else positive
was highlighted, without disclosing the switch.

The documents used in the review were obtained by lawyers suing Pfizer for
refunds on prescriptions paid for by insurers and consumers. The lawyers,
who are seeking class action status for the cases, claim Pfizer concealed
evidence the epilepsy drug Neurontin didn't work for those unapproved uses,
including nerve pain, migraines and bipolar disorder.
One of the report's authors is an expert witness for the plaintiffs; another
has received fees from the lawyers.

Pfizer disputes the report's conclusions, saying the company never
"attempted to mislead the medical community about the effectiveness" of the
drug for certain uses.

"We believe the review suffers from significant bias, insufficient data,
poor methodology, and cannot pass the threshold of credible scientific
research," Pfizer said in a statement.

The report, by researchers at the University of California at San Francisco
and the Johns Hopkins Bloomberg School of Public Health, comes two months
after Pfizer was fined a record $2.3 billion — including an unprecedented
$1.2 billion criminal fine — for illegally marketing other blockbuster
drugs.

The report appears in Thursday's New England Journal of Medicine.
Dr. Sidney Wolfe, head of health research at consumer group Public Citizen,
called it the first comprehensive look "at studies in which a company and
people working for it so maliciously manipulated the data to make a drug
look more effective than it actually was."

"In every instance, the published article made the drug look better than it
would have," said Wolfe, a member of the Food and Drug Administration's drug
safety advisory committee. "This results in harm."

HALF WAY THERE TO HEALTH CARE NOW!

2009-11-07T22:24:00.000-08:00

House Narrowly Passes Historic Health Care Bill

Posted: 11/7/09Filed Under:House, Democrats, Republicans, Abortion, Health Care, The Capitolist, Congress, Deficit 1233 Comments + Join the discussion »TEXT SIZE:AAAPRINT SHARE The U.S. House of Representatives narrowly passed a massive overhaul of the American health care system Saturday night by a vote of 220 to 215. One Republican, Rep. Joseph Cao of Louisiana, crossed the aisle, while 39 Democrats joined the Republicans in opposing the measure.

House Speaker Nancy Pelosi called passage of the bill "an historic moment for our nation and for America's families," while Republicans warned that the bill will raise taxes, increase insurance premiums and make cuts to Medicare. An enormous round of applause broke out throughout the House chamber when the crucial 218th vote was cast to ensure the bill's passage.

The $1.3 trillion-dollar bill would require individuals to buy health insurance, and would also require medium and large businesses to provide it to their employees. Consumers would be able to buy their insurance on an exchange, which would include a public insurance option for people who do not have access to insurance through their jobs. Low- and middle-income families would receive government subsidies to purchase insurance, which would be be paid for through tax increases on individuals making more than $500,000 per year, as well as fees on medical providers. Finally, the bill would prohibit insurance companies from dropping or denying coverage based on pre-existing conditions or cost of care.

The day of the vote was punctuated by high drama, as the House gaveled into a rare weekend session with no indication of whether the Speaker had all 218 votes necessary to pass the bill. But a last- minute addition to the bill to appease pro-life Democrats, as well as a high-profile visit from President Obama to press Democratic members to vote for the measure, provided just enough momentum to pass it through the House with two votes to spare.

House Majority Leader Steny Hoyer began the debate by saying, "This is not a new idea, but it is an idea whose time has come." Hoyer said that the bill under consideration was not perfect, but was the result of "careful scrutiny, hard work, citizen input, and is the right response to this time of economic insecurity in which we find ourselves."

Pelosi added that the bill would also reduce drug costs for seniors, prevent insurance companies from charging women more than men for the same coverage, and would allow young adults to stay on their parents' insurance until their 27th birthdays. She also promised that the bill would add "not one dime to the deficit."

Republicans countered that the bill will in fact explode the deficit and give the federal government an out-sized and improper role in Americans' health care decisions. Rep. Joe Barton (R-Tx.) said, "I just don't think it's right that in the guise of helping Americans, we're telling Americans what they have to do."

Rep. Marsha Blackburn (R-Tenn.) said that the federal government is not capable of running many of the programs it is already responsible for, and should not be trusted with more responsibilities for Americans' health care: "We have talked to mothers who say, 'You can't even get the H1-N1 vaccine out there and you think you're going to handle the health care for my children?' " Manufacturers have not been able to supply enough of the vaccine because of the difficulty of producing it.

Rep. Phil Gingrey (R-Ga.) warned, "I have no doubt that although the American people may forget what was said here, they will never forget what was done here and who did it to them."

A crucial barrier to the bill was eliminated when the House passed an amendment by Rep. Bart Stupak (D-Mich.), a pro-life Democrat, by a vote of 240 to 192. Stupak's measure would prevent insurance companies from participating in the new government exchange if they also cover abortion. It would also require women enrolled in the exchange to purchase supplemental abortion insurance with private funds if they want to be covered for the service in the future.

Speaking on the House floor Saturday, Stupak called the existing House bill a "direct assault" on existing limits to federal funding for abortion, but pro-choice Democrats lined up in staunch opposition to his effort. Rep. Jan Schakowsky (D-Ill.) called Stupak's amendment "an insult to millions of American women," while Rep. Diana DeGette (D-Colo.) said, "To say that this amendment is a wolf in sheep's clothing would be the understatement of a lifetime. If enacted this will be the greatest restriction on a woman's right to choose in our careers."

Although Pelosi initially resisted the Stupak amendment, the congressman had garnered commitments from more than 40 fellow pro-life Democrats to derail the entire health reform effort without stricter apportion language in the bill. Despite Stupak's victory Saturday, opponents of his measure vowed to strip it from the final bill in the conference committee.

Before voting on final passage, the House defeated the Republicans' significantly smaller alternative health care reform proposal by a vote of 176 to 258, with one Republican, Rep. Tim Johnson, voting against it. The Congressional Budget Office estimated the measure would have cost $61 billion over ten years. It would have expanded high-risk insurance pools and would have revised and expanded the use of health savings accounts, but would not have changed insurance companies' policies of refusing coverage for pre-existing conditions.

Now that the House has passed its version of health care reform, all eyes will be on the Senate, where moderate Democrats have already balked at the Senate bill's cost and scope.

Because the Senate measure already differs significantly from the House bill on everything from the nature of the public option (the Senate lets states opt-out), to income taxes increases (only the House has them), yet another hurdle awaits in the conference committee, where the House and Senate versions will be combined before a final vote in both chambers.

In a statement late Saturday, President Barack Obama thanked the House for its work in passing health care reform and said he is "confident" the Senate will follow suit, adding, "I look forward to signing comprehensive health insurance reform into law by the end of the year."

Maybe LAST CHANCE for YOU to Make a Difference: Call your Congressperson NOW

2009-11-07T06:04:00.000-08:00

Health Care NOW to be voted on in the House of Representatives. It is TIME to FIX our broken health care system. Let your Congressperson know how you feel. Call today.

WASHINGTON (Nov. 7) - President Barack Obama is traveling to Capitol Hill on Saturday to try to close the sale on his signature health care overhaul, facing a make-or-break vote in the House certain to be seen as a test of his presidency.
Obama scheduled a late-morning visit with House Democrats convening a rare Saturday session on legislation to remake the U.S. health care system, extending coverage to tens of millions now uninsured and banning insurance company practices such as denial of coverage based on pre-existing medical problems.

Late Friday, House Democrats cleared an abortion-related impasse blocking a vote and officials expressed optimism they had finally lined up the support needed to pass Obama's signature issue.

Under the arrangement, Democratic Reps. Bart Stupak of Michigan, Brad Ellsworth of Indiana and other abortion opponents were promised an opportunity to insert tougher restrictions into the legislation during debate on the House floor.

The leadership's hope is that no matter how that vote turns out, Democrats on both sides of the abortion divide will then unite to give the health care bill a majority over unanimous Republican opposition.

"We wish to maintain current law, which says no public funding for abortion," Stupak said. "We are not writing a new federal abortion policy."
Ellsworth added, "From day one, my goal has been to ensure federal tax dollars are not used to pay for abortions and to provide Americans with pro-life options on the exchange. And I am proud to be part of an effort to help make this goal a reality."
With Democrats' command of the necessary votes looking tenuous in the final hours, Obama threw the weight of his administration behind the effort to round up support. He and top administration officials worked the phones to pressure wavering lawmakers.
Rep. Jason Altmire, D-Pa., said he heard Friday from Obama, White House Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan.

Their message: "This is a historic moment. You don't want to end up with nothing," said Altmire, who remained undecided.

Democratic leaders hoped to hold the vote Saturday evening, but Majority Leader Steny Hoyer said it could slip.

Democrats hold 258 seats in the House and can afford 40 defections and still wind up with 218, a majority if all lawmakers vote. But all 177 Republicans were expected to vote "no," and Democratic leaders faced a series of complications trying to seal the needed votes for their complex and controversial legislation that would affect one-sixth of the economy and touch the lives of countless Americans.

In the GOP's weekly radio address, Mississippi Gov. Haley Barbour said Democrats should scrap their ambitious legislation and concentrate on modest health care changes that could find bipartisan support.

"The House Democrats' health care bill should be withdrawn and reworked," he said.
Tuesday's elections — in which Democrats lost two governors' races — sent a message that voters care about jobs, not growing the size of government, Barbour said.
The final hurdle for the Democrats was a controversy over federal funding for abortion, which simmered into Friday night with tensions running high as party leaders shuttled between meetings of anti-abortion and abortion rights lawmakers.
Federal law currently prohibits the use of federal funds to pay for abortions except in the case of rape, incest of situations in which the life of the mother is in danger. That left unresolved whether individuals would be permitted to use their own funds to buy insurance coverage for the procedure in the federally backed insurance exchange envisioned under the legislation.

Democrats have little room for error, with the prospect of the 2010 midterms looming large and a some of their own moderates already declaring their opposition.
The 10-year, $1.2 trillion House bill would create a new federally supervised insurance marketplace where the uninsured could purchase coverage.
Consumers would have the option of picking a government-run plan, the most hotly contested item in the legislation.

Associated Press writers David Espo and Ricardo Alonso-Zaldivar contributed to this report.

Cancer Treatment and Health Care Reform

2009-11-03T00:31:00.000-08:00

From Barbara O’Brien

One argument you may hear against health care reform concerns cancer survival rates. The United States has higher cancer survivor rates than countries with national health care systems, we’re told. Doesn’t this mean we should keep what we’ve got and not change it?

Certainly cancer survival rates are a critical issue for people suffering from the deadly lung cancer mesothelioma. So let’s look at this claim and see if there is any substance to it.

First, it’s important to understand that “cancer survival rate” doesn’t mean the rate of people who are cured of a cancer. The cancer survival rate is the percentage of people who survive a certain type of cancer for a specific amount of time, usually five years after diagnosis.

For example, according to the Mayo Clinic, the survivor rate of prostate cancer in the United States is 98 percent. This means that 98 percent of men diagnosed with prostate cancer are still alive five years later. However, this statistic does not tell us whether the men who have survived for five years still have cancer or what number of them may die from it eventually.

Misunderstanding of the term “survivor rate” sometimes is exploited to make misleading claims. For example, in 2007 a pharmaceutical company promoting a drug used to treat colon cancer released statistics showing superior survival rates for its drug over other treatments. Some journalists who used this data in their reporting assumed it meant that the people who survived were cured of cancer, and they wrote that the drug “saved lives.” The drug did extend the lives of of patients, on average by a few months. However, the mortality rate for people who used this drug — meaning the rate of patients who died of the disease — was not improved.

But bloggers and editorial writers who oppose health care reform seized these stories about “saving lives,” noting that this wondrous drug was available in the United States for at least a year before it was in use in Great Britain. Further, Britain has lower cancer survival rates than the U.S. This proved, they said, the superiority of U.S. health care over “socialist” countries.

This is one way propagandists use data to argue that health care in the United States is superior to countries with government-funded health care systems. They selectively compare the most favorable data from the United States with data from the nations least successful at treating cancer. A favorite “comparison” country is Great Britain, whose underfunded National Health Service is struggling.

It is true that the United States compares very well in the area of cancer survival rates, but other countries with national health care systems have similar results.

For example, in 2008 the British medical journal Lancet Oncology published a widely hailed study comparing cancer survival rates in 31 countries. Called the CONCORD study, the researchers found that United States has the highest survival rates for breast and prostate cancer. However, Japan has the highest survival for colon and rectal cancers in men, and France has the highest survival for colon and rectal cancers in women. Canada and Australia also ranked relatively high for most cancers. The differences in the survival data for these “best” countries is very small, and is possibly caused by discrepancies in reporting of data and not the treatment result itself.

And it should be noted that Japan, France, Canada and Australia all have government-funded national health care systems. So, there is no reason to assume that changing the way health care is funded in the U.S. would reduce the quality of cancer care.

—

Seventy-Two Year Old Patty Zeitlin Raps about HEALTH CARE NOW

2009-10-31T21:05:00.000-07:00

Patty is a senior citizen who is mad as hell and won't take it anymore. View Patty's RAP on You Tube......LEARN and Enjoy

http://www.youtube.com/watch?v=lTjoHqurBUg

Thank you Senator Harry Ried

2009-10-29T11:06:00.000-07:00

For months, Senate Majority Leader Harry Reid has been under intense pressure to drop the public health insurance option.

But Reid defied insurance lobbyists, political pundits, and conservatives of both parties and announced that he's including a public option in the Senate floor bill.

I just added my name to a newspaper ad thanking Senator Reid, to show that thousands of Americans have got his back and are fired up to fight alongside him. You can participate as well.

The Senate's version of the Health Reform Bill includes a public option with negotiated provider rates. The result of the passage of this bill will be a resolving of the access to health care affecting millions of Americans, and the plummeting of health care costs due to competition. The bill is not perfect, but the Senate version is the best I have reviewed so far. If you would like to lend your name in supporting Senator Reid, go to the following link and sign on.
http://pol.moveon.org/thankreid/?r_by=17734-8124316-HYvJJwx&rc=confemail

Washington Post "New Life for the Public Option"

2009-10-26T14:13:00.000-07:00

New life for the public option

The resurrection of the public option is the latest and one of the most surprising turns in the long battle over legislation to overhaul the nation's health-care system. Under assault for months, and declared on life support repeatedly in recent weeks, the provision for a public insurance option is unexpectedly alive as House and Senate leaders prepare to send their bills to the floor.

That doesn't mean it's a done deal. Whether it survives the final battles, and in what form, are still the unanswerable questions. Multiple versions of a public option are on the table. Liberal and moderate Democrats are still at odds and are drawing lines in the sand in hopes of exercising maximum influence on the outcome.

Senate Majority Leader Harry M. Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) are still scratching for the votes to pass bills with a public option included. But by next week, both hope to have bills ready either for unveiling or to send to the Congressional Budget Office for analysis and scoring.

What encourages some of those who have followed this debate closely from the inside is the degree to which Democrats are in sight of a compromise on the public option and other remaining differences -- though many may have to accept some disappointment to get a bill to President Obama's desk.

What brought the public option back to life?

Conservative opposition nearly sank the public option over the summer. Many Republicans called it a government takeover of health care. Some conservatives see it as the first step toward a single-payer system (as do some liberals). At the height of the town hall and Tea Party activity, the White House appeared to be running for cover. Officials worried that the public option had become a proxy for more pervasive concerns about the amount of government intervention Obama was calling for in his economic and domestic policies.

Administration officials sent equivocating signals. White House Chief of Staff Rahm Emanuel, driven by a pragmatic desire to get a bill through Congress, appeared willing to sacrifice the public option, if necessary, to reach the larger goal. The president maintained that he still preferred to see a public option in the legislation, but he told one town hall audience that this was merely "a sliver" of the overall health-care debate. In other words, if it sank into obscurity, he wouldn't weep long over its disappearance.

The conservative opposition and the administration's apparent wobbliness prompted a counterattack by liberal advocates of the public option, who saw it as the holy grail of the debate. Few experts see it that way, and there are no doubt far more important provisions that would have a more direct effect on coverage, on how individuals are treated by their insurance companies and in controlling costs (still the weakest element of bills under consideration). But the grass-roots support had an effect.

When Congress returned to Washington in September, the debate's focus shifted to the dynamics of the Senate Finance Committee, where Chairman Max Baucus (D-Mont.) had labored for months to produce a bipartisan consensus. To that end, he joined several other Democrats in opposing two versions of a public option in the committee's bill, saying he saw no way to get 60 votes in the full Senate.

That seemed to spell the end for the public option. Baucus, however, managed to get one Republican, Sen. Olympia Snowe (Maine), to join with Democrats in approving the legislation. Snowe opposes a public option, but she has advocated the use of a trigger mechanism that would allow a government insurance plan if private competition proves inadequate. Snowe's future votes remain conditioned on what is in the final bill.

With virtually unanimous Republican opposition likely, Democrats reevaluated the politics of the public option. Two recent events contributed to their renewed push to include it. One was the insurance industry's decision to attack the legislation and issue a report warning of higher premiums. The report triggered a backlash among liberal Democrats, who decided to push even harder for a public option.

Then last week, new polls, one from The Washington Post and ABC News and the other from the Henry J. Kaiser Family Foundation, found clear majority support (57 percent) for a public option. The Post-ABC News poll showed support had risen five percentage points since August. The new numbers emboldened public-option supporters to press harder, even though the same polls continued to show the public divided over the overall shape of health-care legislation.

National polls are one thing. But getting the votes in the House and Senate is quite another. For red-state senators or House Democrats from marginal districts, perceptions of public opinion at home are another, which is why rounding up the votes for a bill with a public option remains a challenge.

Pelosi has long been a determined advocate for the public option. The most robust version, which would pay on the basis of Medicare rates, appears not to have enough votes to get through the House. As of this weekend, Pelosi's fallback appears to be a provision that pays on the basis of negotiated rates, still a relatively robust approach.

Reid is trying to attract 60 votes for a bill with a more qualified public option, one that would let states opt out of the system. Even if he is a few votes short, Reid is inclined to include the option in the bill that goes to the floor. Snowe's trigger mechanism may be the fallback position in the Senate if there aren't 60 votes for an opt-out plan.

On Friday, Pelosi signaled her receptivity to the opt-out approach as a possible compromise between the House and Senate, a sign that despite her advocacy for a robust public option she doesn't want to jeopardize reelection prospects for the moderate-conservative members of her caucus.

Much negotiating and posturing lie ahead. Obama told Senate leaders late last week he still sees value in trying to keep Snowe in the coalition. But liberal Democrats will be unhappy if the Senate bill includes her trigger mechanism rather than something stronger.

That will then test Democrats' cohesiveness, and Obama's leadership and persuasiveness. That battle could be weeks away. The fact that the House and Senate now appear likely to receive health-care bills with a public-option provision is surprise enough.

Final Senate Bill to Have PUBLIC OPTION

2009-10-26T13:27:00.000-07:00

Reid says health care bill to have public option By DAVID ESPO and ERICA WERNER, AP
posted: 18 MINUTES AGOcomments: 459PRINT|E-MAILMOREText SizeAAAWASHINGTON -

Majority Leader Harry Reid says health care legislation headed to the Senate floor will include an option for government-run insurance. Reid says states will have the prerogative of opting out of the program if they choose.

Reid noted that polls show widespread public support for giving the government a role in the overhauled health care system envisioned by President Barack Obama and his allies in Congress.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
2009-10-26 16:08:11

REAL HEALTH CARE REFORM NOT DEAD YET

2009-10-24T17:13:00.000-07:00

Contact your Senators and Congressperson immediately. Let them know that the ONLY real health care reform MUST include a public option. Get involved, we can impact Health Care NOW. A Public Option will ensure access to health care and reduce costs through competition.

A Second Wind for the 'Public Option'
Posted: 10/24/09Filed Under:Nancy Pelosi, Health Care, Harry Reid 25 Comments + Join the discussion »TEXT SIZE:AAAPRINT SHARE To the surprise of many, the so-called "public option" - creating a gvoernment-backed insurance plan to compete with prviate insurers - is squarely back on the table after being considered dead by some, according to the Washington Post.

The Post says that Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi are trying to round up votes to pass the public option in some form. One of the reasons for its revival may have been a series of recent public opinion polls that showed a rise in support for the proposal.

THIS SHOULD NEVER HAPPEN TO YOU

2009-10-23T08:07:00.000-07:00

October 23, 2009

Last Friday we were notified that a patient of ours receiving a MRI had her insurance canceled by Blue Cross of California. Turns out that the MRI revealed cancer. The scan was performed in mid September, and the patient was notified of the cancellation last week retroactive to July 2009. This is NOT the first time Blue Cross has done this. You could be next!

This afternoon, Speaker Nancy Pelosi and other House leaders are making a decision on whether to include a public option in the House health care bill. Pelosi is leading the charge to put the public option in the bill, but she needs to be sure she has the votes to pass it on the House floor.

According to news reports last night, she's still 2 votes shy, so our participation is REQUIRED now.

Representative Henry Waxman is a key member of House leadership. Please call and urge him to stand with Speaker Pelosi and support the public health insurance option. A public option is the ONLY way to ensure Blue Cross and other companies won't treat you like they did our patient.

Here's where to call:

Representative Henry Waxman
Phone: 202-225-3976

Here are some points you might want to make when you call:

A public option is good fiscal policy. It will create competition and reduce health care costs. A new report from the Congressional Budget Office shows legislation with a public option is not just deficit neutral—it will help reduce the deficit.

Legislation with the public option will expand health coverage to 96% of Americans. The USA is the only industrialized country in the world without universal health care for their people.

The public option is widely popular—poll after poll shows strong support, including the latest poll released just this week by The Washington Post.

Health care legislation with the a public option would express the concern of all Americans for their fellow citizens. We do not live in an isolated environment. We need each other to promote our health and the health of our children. No United States Citizen should have to go bankrupt because they can't pay inflated medical bills. A public OPTION in the House of Representatives bill could be decided today.

Please call Rep. Waxman right away

The Time to act is NOW.......MAKE THE CALL

2009-10-22T22:14:00.000-07:00

People from across the country are coming together to send a strong message to Congress: It’s time to deliver on health reform.

Join me in participating in a national call-in day to flood the capitol switchboard with calls in support of meaningful health reform.

Copy and Paste the link below to be connected automatically, or call 1-800-828-0498:

http://www.standupforhealthcare.org/timetodeliver

The facts are clear. The status quo is unsustainable. American families can no longer stand to shoulder the burden of rising health care costs.

It's time to put an end to insurance company abuses – it’s time to put people before profits. No American should suffer or go broke because they lack health insurance.

Please join us in sending a strong message to Congress that the time for health reform is now. We cannot afford to wait.

MORE ADVERTISING BS: MEDICARE TO GO BK IN 2017

2009-10-12T12:27:00.000-07:00

Going Out OF Business?
A new ad goes too far when it says Medicare will be "bankrupt" in eight years.
October 7, 2009

Summary
A new health care ad from a conservative group claims that "Medicare will be bankrupt in eight years." That gives a false impression. The program does have huge financial problems, but there’s no reason to think it’s going out of business as the word "bankrupt" implies. And the issue isn’t new:

A government report the ad refers to says the trust fund for one part of Medicare – hospital insurance – won’t have enough money to pay all benefits in 2017. Medicare’s physician and drug benefits will "remain adequately financed," says the report.
Government projections have found that the hospital insurance trust fund would face a shortfall "almost from its inception," according to the Congressional Research Service. But in many cases politicians have found ways to extend it. In 1970, for instance, the trust fund was expected to be insolvent in 1972.
The ad also claims that "some want to pay for health care reform with $500 billion dollars in Medicare spending cuts." Actually, the House health care bill, to which this refers, proposes a net cut in spending of $219 billion over 10 years.

Analysis
The conservative group Americans for Prosperity has released a new 60-second ad through its Patients First project. The ad, which features a family doctor, Dr. Amy Siems, talking to viewers, recycles a few misleading talking points against health care legislation in Congress, but includes a new claim that is quite startling. Dr. Siems says that "Medicare will be bankrupt in eight years."

Bankrupt? Within a Decade?

Yikes. Quite a scary claim to make about a program that encompasses 16 percent of the federal budget and benefits 45 million Americans. But the word "bankrupt" is far too strong to accurately describe Medicare’s problems.

The AFP/Patients First ad points to a government report as the source of its claim, and that report does say Medicare’s "[p]rojected long run program costs are not sustainable," and that its problems are even more severe than those of Social Security. The report says further that the trust fund for one part of Medicare – hospital insurance – is projected to be insolvent in 2017, and calls that "an urgent concern." But that’s not the same thing as being "bankrupt," and it only applies to one of four distinct parts of the overall Medicare program. As the Social Security Administration explains:

Hospital insurance (Part A) pays for inpatient hospital services, skilled nursing facility care and hospice care.
Medical insurance (Part B) covers physician services and medical supplies not paid for by Part A.

Medicare Advantage (Part C) is an option to receive benefits through a private insurance company.

Part D is Medicare’s prescription drug coverage.

The ad refers to the Social Security and Medicare Boards of Trustees 2009 Annual Report, which indeed makes some dire predictions for Medicare Part A, the segment that’s in danger of running out of money. Part A relies primarily on payroll taxes and its trust fund, or reserves, to pay for benefits. Parts B and D, meanwhile, funded by general revenues and monthly premiums, "are both projected to remain adequately financed into the indefinite future," according to the report. (The trust fund for those segments, though, "will continue to require general revenue financing and charges on beneficiaries that grow substantially faster than the economy and beneficiary incomes over time.")

Funds for Part A will only be able to pay 81 percent of the projected spending in 2017, and less each year after that, according to the trustees’ estimates:

Trustees Report: The projected date of HI [Hospital Insurance]Trust Fund exhaustion is 2017, two years earlier than in last year’s report, when dedicated revenues would be sufficient to pay 81 percent of HI costs. Projected HI dedicated revenues fall short of outlays by rapidly increasing margins in all future years.

The report goes on to say that the HI trust fund "could be brought into actuarial balance over the next 75 years" by either significantly increasing the payroll tax which funds it, cutting spending by half, or a combination of those measures. "Larger changes would be required to make the program solvent beyond the 75-year horizon," the report says.

But warnings of depleting the HI trust fund aren’t new. In a 2008 report, the Congressional Research Service wrote that "almost from its inception, the HI trust fund has faced a projected shortfall. The insolvency date has been postponed a number of times, primarily due to legislative changes which had the effect of restraining growth in program spending." Indeed, a 1983 report from the Senate’s Special Committee on Aging forecasted that:

Senate Special Committee on Aging, 1983 report: Balances in the HI trust fund are projected to be exhausted during 1987. Though the HI balance was a substantial $18.7 billion at the end of 1981, borrowing by the old-age and survivors insurance trust fund (OASI) reduced the HI balance to $8.3 billion at the end of 1982. … This already low balance is projected to decline slowly through 1986 and rapidly in ensuing years, as outlays exceed income by a widening margin.

And that is hardly the only year in which a government report projected shortfalls just around the corner, as this table, re-created from a CRS report, makes clear:

We don’t mean to say that the projections about the future of the HI trust fund shouldn’t be taken seriously, or that Medicare in general isn’t facing long-term funding issues. But it’s not going to be “bankrupt in eight years.”

The Obama administration has commented on the trustees report several times. Health and Human Services Secretary Kathleen Sebelius called it “a wake up call for everyone who is concerned about Medicare and the health of our economy,” adding that “it’s yet another sign that we can’t wait for real, comprehensive health reform.” And the administration has put forth proposals that it says will extend the life of the trust fund by several years.

We can’t predict whether the Obama administration and Congress will find a way to save the HI trust fund yet again, but judging from the political past, it seems likely.

At the point where the hospital insurance trust fund is expected to run dry in 2017, the current payroll tax is estimated to cover only 81 percent of the projected outlays (compared to 88 percent this year), and less each year after that. In the past, scheduled depletions have been offset by a combination of increased taxes and other funding, as well as decreased payouts. The original HI tax rate was 0.35 percent in 1966 and increased steadily over the next three decades. It is now 1.45 percent on all covered earnings, and both the employee and the employer pay it. Hospitals, meanwhile, accept Medicare payments that are about 68 percent of what private insurance pays, according to the Lewin Group, and in July, hospitals agreed to cutting $155 billion in Medicare and Medicaid over 10 years, primarily through adjusting annual payment increases.

Other Claims

We’ve examined ads from Patients First and its parent group, Americans for Prosperity, before, and they’ve put forth the same straw man argument: that Congress wants a Canadian- or British-style health care system. As we’ve pointed out in several articles, that’s not what the legislation in Congress would set up. As evidence, the back-up for this ad includes a column in the Tucson Citizen that repeats falsehoods we’ve already debunked about the stimulus bill, which was passed in February.

The group’s support also includes several articles about patients in Canada waiting for specialist appointments, MRIs and even surgeries. It’s Dr. Siems’ opinion that this amounts to a “system that has already failed.” Others would disagree, such as a Canadian scientist quoted in a 2007 article that’s among the group’s back-up: " ‘Canada is not a medical utopia, as some would have you believe, or a disaster, as others claim,’ said Jack Tu, a senior scientist at the Toronto-based Institute for Clinical Evaluative Sciences and co-author of a recent study on waiting times. ‘Most people get care in a reasonable amount of time. What you hear about are the horror stories.’ "

But a debate on whether or not the system has “failed” north of our border is irrelevant. The health care legislation in Congress doesn’t amount to “forcing Americans” into such a system, anyway.

The doctor in the ad also says that "some want to pay for health care reform with $500 billion in Medicare spending cuts.” But that’s more than double the net amount the House legislation proposes to save from Medicare. It’s true that the House health care bill calls for getting $500 billion in savings out of Medicare, but its substantial increases in Medicare spending reduce the net amount cut from the program to $219 billion over 10 years, according to the Congressional Budget Office.

– by Justin Bank and Lori Robertson

Sources
“Financing Medicare: An Issue Brief.” The Kaiser Family Foundation. Jan 2008.

Medicare, SSA Publication No. 05-10043. Social Security Administration. Sep 2009.

Status of the Social Security and Medicare Programs. A Summary of the 2009 Annual Reports. Social Security and Medicare Boards of Trustees. 2009.

“Prospects for Medicare’s Hospital Insurance Trust Fund.” Special Committee on Aging, United States Senate. Mar 1983.

O’Sullivan, Jennifer. “Medicare: History of Part A Trust Fund Insolvency Projections.” Congressional Research Service. 28 Mar 2008.

Department of Health and Human Services. Sebelius Statement on New Medicare Trustees’ Report, news release. 12 May 2009.

WhiteHouse.gov. Paying for Health Care Reform, Medicare fact sheet. Accessed 7 Oct 2008.

Congressional Budget Office. Letter to Rep. Charles B. Rangel. 17 Jul 2009.

Davis, Henry L. “Is universal health care worth waiting for?” Buffalo News. 29 Jul 2007.
Posted by Justin Bank and Lori Robertson on Wednesday, October 7, 2009 at 5:45 pm
Filed under Articles · Tagged with Americans for Prosperity, medicare

Do you have the courage to take on the pharmaceutical companies, health insurance companies, medical device companies, your colleagues in the Senate?

2009-09-29T14:12:00.000-07:00

Dear Senator Feinstein:
Thank you very much for responding to my email supporting health care reform.

For the record, I am a board certified medical psychologist and pain management specialist practicing in Los Angeles since 1972. I along with many of my colleagues (most on staff at Cedars Sinai, Brotman Medical Center, and Olympia Hospital) support health care reform.

More importantly we support insurance reform. It is admirable to pass legislation prohibiting insurance companies to deny coverage. However, that will not reduce the cost of care.

I have been practicing for 37 years and I believe the only cost cutting device is COMPETITION. If insurance companies had to compete with a public option, if providers had to compete for patients, the cost of health care would plummet.

Further, treating health care as a commodity like we do pork bellies and General Electric is flat out wrong. Corporations must make a profit. Health insurance companies make a profit from sick or injured people. There is somethng terribly and inherently wrong with this picture. Moreover, the profits by insurance companies are significantly increased by denying coverage or delaying treatment. These health insurance companies should be held accountable for the tens of thousands of people in the US who die each year for lack of coverage.

There are other changes that also need to take place to fix our broken health care system. Medicare rules MUST change. Using the CMS reimbursement as a base is fine, but the rule must allow for provider and patient to negotiate balances as opposed to forcing the provider to accept assignment. This will also result in cost containment because the patient will know prior to receiving health care what their out of pocket expense will be. Since providers will have to compete for patients, patients will benefit from this change in rules. The net effect of changing Medicare would be to put the health care decision making where it belongs; between provider and patient. Further, this change would put free enterprise back into medicine.

There must be changes in Tort law as well. Frivolous lawsuits should be disallowed with a mandate to the insurance companies to lower the premiums to providers.

The pharmaceutical and medical device companies also need reform. Two weeks ago we performed a neurostimulator implant surgery at our Los Angeles ambulatory surgery center. Our cost for the neurostimulator was $25,000. I would be willing to bet that the cost of manufacturing the device is less than $2500.

I can provide you with many examples and invoices from surgery equipment and supply vendors revealing the inflated and obscene charges from these companies. There is NO accountability and very little if any competition. These companies have been getting away with these outrageous charges since the early 1980's. Our elected representatives accept campaign contributions from all of these companies. I believe this is a major and significant reason why our health care system is broken.

As you well know, the drug companies are just as bad. Same drug, same manufacturer will sell for 10 times less in Canada or Mexico or any other country in the world than in the USA. The pharmaceutical and medical device companies drive the pricing in health care and it is time for you and your colleagues to STOP them. The only reason they get away with robbery is that we are the ONLY country in the industrialized world that does not have universal health care for their people.

You want to ensure access to health care to all of your constituents? You want to drive health care costs DOWN? You only need to look at the insurance industry, pharmaceutical industry, medical device industry and congress protecting them to make that happen. The solution is a lot simpler than you and your colleagues make it out to be.

Do you have the courage to take on the insurance companies? Pharmaceutical companies? Medical Device companies? You would make all Californians proud if you took them on.

I think it would be very beneficial for you to look at the New Zealand health care system. It is a combination of public and private health care that really works.

My colleagues and I are available to discuss any of these issues with you or your staff, and thank you for listening.

Howard Stanley Rubin, MP PhD
Chief Executive Officer
Museum Center Surgery Group, Inc.
Los Angeles, California
http://healthcarenow-doc.blogspot.com/

KAISER SURVEY FINDS INCREASED PUBLIC SUPPORT FOR HEALTH CARE AND INSURANCE REFORM

2009-09-29T10:23:00.000-07:00

NEWS RELEASE
Tuesday, September 29, 2009

Public Support For Health Reform Increases in September, Reversing Summer Declines as Congress Takes Up Legislation

Survey Finds Support For New Proposals For Fees And Taxes on Insurance Companies to Help Pay For Overhaul

CONTACTS

Chris Lee(202) 347-5270CLee@kff.org
Rakesh Singh(650) 854-9400RSingh@kff.org

MENLO PARK, CA -- Public support for health reform ended its summer slide, reversed course and moved modestly upwards in September, according to the latest Kaiser Health Tracking Poll.

Fifty-seven percent of Americans now believe that tackling health care reform is more important than ever -- up from 53 percent in August. The proportion of Americans who think their families would be better off if health reform passes is up six percentage points (42% versus 36% in August), and the percentage who think that the country would be better off is up eight points (to 53% from 45% in August).

Despite the uptick, a substantial share of the public (47%) favors taking longer to work out a bipartisan approach to health reform, compared to 42 percent who would prefer to see Democrats move faster on their own. Meanwhile, the public continues to view the action in Washington with mixed feelings: The largest share (68%) said they were "hopeful" about reform, but 50% are "anxious" and 31% "angry."

"Opinion in the coming months is hard to predict, but as the focus shifted from the town halls and hot button issues to the President, the Congress and the core issues in the legislation that affect people the most, the summer downturn in support was largely erased," said Kaiser President and CEO Drew Altman.

Upswing in Support Driven by Changes Among Republicans and Independents

Republicans and political independents became markedly more pessimistic about health reform in August, but those viewpoints softened in September. While 49 percent of Republicans say their family would be worse off if health reform passes, this is down from 61 percent in August.

The percentage of independents saying they would be worse off fell from 36 percent in August to 26 percent this month.

Democrats remain overwhelmingly in favor of tackling health care now (77%), while most Republicans say we cannot afford to do so (63%) and independents are more evenly divided (51% in favor and 44% opposed).

Fifty-seven percent of the public -- including 56% of independents -- say the GOP is opposing reform plans more for political reasons than because they think reform will be bad for the country.

Majority Backing Seen for Taxing Expensive Health Plans and Imposing Fees on Insurers to Pay for Reform

Substantial majorities of Americans continue to say they back individual reform components designed to expand coverage, including an individual mandate (68%), an employer mandate (67%) and an expansion of state programs such as Medicaid and the Children’s Health Insurance Program (82%).

The component that draws among the strongest support across the political spectrum is requiring that health insurance companies cover anyone who applies, even if they are sick or have a pre-existing condition. Overall, 8 in 10 people support that idea, including 67 percent of Republicans, 80 percent of independents and 88 percent of Democrats.

When it comes to paying for reform, two ideas now under discussion among policymakers garner initial majority support. Fifty-seven percent of the public say they would support "having health insurance companies pay a fee based on how much business they have" and 59 percent would support "having health insurance companies pay a tax for offering very expensive policies." In both cases, Republicans are evenly divided while Democrats and political independents tilt in favor. The poll did not test arguments for and against the policies.

Messages Matter

People say they would be more likely to support a new reform proposal if they heard it would:
Improve health care for our children and grandchildren (77%);

Provide financial help to buy health insurance to those who need it (74%);

Help ensure the long-term financial health of Medicare (69%);

Fulfill a moral obligation by ensuring that people don’t have to go without needed health care just because they can’t afford it (68%); and

Mean that people with a history of illness would not be denied coverage and could get it at the same price as healthier people (65%).

Conversely, people say they would be less likely to support a new reform proposal if they heard that it would:

Limit choice of doctors (65%);

Reduce the quality of care provided to seniors under Medicare (63%);

Result in payment cuts that might make doctors less willing to take Medicare patients (62%);

Get the government too involved in your personal health care decisions (59%);

and Increase people’s insurance premiums or other out-of-pocket costs (57%).

Seniors Are Still Less Convinced Reform Will Benefit Them

Seniors are still less convinced than others that health reform will benefit them, but they too have become less pessimistic since August. The share of seniors who think their family would be better off if reform passes climbed 8 percentage points from August, from 23 percent to 31 percent. Twenty-eight percent thought they would be worse off, and 33 percent said it wouldn’t make a difference. Fifty-five percent of seniors said they were 'confused."

Some commentators believe that proposals to obtain savings in the Medicare program are driving opposition among seniors. The survey finds that a plurality of seniors (49%) opposed the idea of limiting future increases in Medicare provider payments as a way to help pay for health care reform. But a solid majority (59%) would back the same limits if they were framed as helping to "keep Medicare financially sound in the future."

"Some Medicare changes being discussed in the health reform debate can be seen as strengthening Medicare for the long-term or as harming it. Which of these messages breaks through could ultimately shape seniors’ reactions," said Mollyann Brodie, vice president for Public Opinion and Survey Research at the Kaiser Family Foundation.

Many Say News Coverage Has Focused on Politics and Controversy

Health reform is the top story out of Washington, with news organizations ramping up coverage in recent months. In assessing the job of the media, 50 percent of the public says news coverage of health reform "has been mostly about politics and controversies," while eight percent say it has been mostly about "how policy reforms might affect your own family." Thirty-seven percent view the coverage as a balance of the two.

Fifty-four percent of the public report that they had seen an ad in the last seven days that had to do with proposed changes in the health care system, up from 45 percent in August and 21 percent in June. The public says that these ads have come fairly evenly from proponents and opponents of reform.

Americans Continue to Struggle with Unaffordable Health Care While policymakers debate solutions, the problem of high health care costs remains. One third of Americans (33%) say they or someone in their household has had problems paying medical bills over the past year. That is up nine percentage points from August and represents the highest level this measure has reached in nearly a year.

A majority of Americans (56%) also say they have put off care over the last 12 months because of cost reasons, with many saying that they had relied on home remedies or over the counter drugs instead of seeing a doctor (44%), skipped dental care or other checkups (35%), or skipped a recommended medical test or treatment (28%).

Methodology
The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted September 11 through September 18, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 147 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.

The full question wording, results, charts and a brief on the poll can be viewed online.
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information, research and analysis on health issues.

Called out on Miracles

2009-09-25T09:56:00.000-07:00

I received this response to yesterday's Blog. Following are the criticism and my response. It would be great to hear from more of you. This issue effects ALL OF US.

There is one thing I'm having a hard time understanding about your (and many liberals' views)....you all want a 'public option' under the guise of increased competition to the insurance companies. But in the next sentence want a single payor system, which would ELIMINATE any competition. You guys should at least be honest and say that you want a public option as a means to eliminate the insurance companies.

Response
What I WANT and what is currently possible are two different things. If you read the blog again, you will find that I was answering a question about what a public option would look like based on my understanding of what is being considered by Congress. In this context, a public option would go a long way in driving costs down due to competition for policy holders and provider competition for patients.

I then addressed the issue of how health care is perceived and understood in the United States. UNFORTUNATELY, we view health care as a commodity or equity like we do pork bellies or General Electric. We are the only industrialized country in the world that views health care this way. In other words, health insurance corporations must profit at the expense of sick or injured people. They do this by denying or delaying treatment, or canceling policies AFTER the policy holder contracts a serious or catastrophic disease. There is something terribly wrong with that picture.

If our government created laws that did not allow profiteering off the sick or injured, health insurance companies would no longer exist. I think that not profiting from a human beings misery is a good thing. Universal health care in other countries is NON PROFIT, paid by tax dollars. That's right, tax dollars.

These countries have NO problem with taking care of their people, unlike us AMERICANS. I have heard so many people talk negatively about single payor system or even a public option because they don't want to pay for other peoples health care. Fact is we are all ready paying for other peoples health care. Those of us lucky enough to be employed pay taxes for Medicare. We are paying NOW for our health care later. We are paying NOW for those 65 or older, or who are disabled. That argument that "I shouldn't have to or don't want to pay for others health care" is shortsighted and WRONG. If this position is liberal, I am guilty.

I have some questions for those of you who actually believe that it is everyone for themselves.

If the US was attacked with biological weapons and you or a family member contracted a serious disease because of this attack; would you want to be obligated to obtain pre certification from your insurance company to be treated? Would you want to subject yourself to their scrutiny and review of your medical history? What if they determined that your policy was not valid because you forgot to document that you were treated for acne when you were a teenager so many years ago? What would you do if your insurance company denied your claim because they determined it was a pre existing condition? What if you had a $5000 deductible and didn't have the money? What if this disease prohibited you from earning a living and you didn't have your $50 co-pay?

My guess is that you wouldn't have any problem with this since your belief is that we should only have to take care of ourselves. I'm certain you would rather suffer in your illness than be treated for it.

Do you believe in Miracles?

2009-09-24T10:01:00.000-07:00

The following letter is in response to a question I was asked in regard to what a "public option" would be like. More specifically, I was asked if the public option was going to be like Medicare.

Sorry it has taken me so long to respond to your question. I have been very busy at the surgery center. My understanding is that the "public option" is one of several health insurance products that will be made available to individuals and small business that currently don't have or provide health insurance. The details have not been fully worked out, but I think the end product will be similar to Medicare in that the government will "outsource" the administration of the public plan to a third party as it currently does for Medicare. Hopefully, that will be the only similarity.

There will need to be some major changes in the current Medicare system to make a public option viable. I have outlined many of the necessary changes in previous posts on the Blog Health Care NOW. Specifically, reimbursement must be increased in order for providers to accept patients participating in the public option, and payroll decutions must be increased to pay for the public option.

One method of increasing reimbursement is to allow providers and their patients negotiate balances. I have suggested a two pronged approach where the current CMS reimbursement is increased 15--20% AND the difference between the providers fee and CMS reimbursement is negotiated with the patient PRIOR to the delivery of the health care service or procedure.

Further, an increase in the Medicare payroll deduction must also take place. This increase should be 10--15%. This increase pales in comparison to deductibles and co-payments currently in existence. This is doable since worker's and self employed people will have choices for their health insurance products and costs will decrease naturally with competition.

This is also true for the NON public plan options. Competition will drive the costs down because providers as well as insurance companies will be competing for patients and policy holders.

One other thing of note. Unfortunately, in the USA, health care is treated as a commodity. It shouldn't be, but it is. If this attitude were to change, private insurance companies would go out of the health care business which would be the best thing ever to happen in health care. It is the insurance industry along with the pharmaceutical companies and medical device companies that are raping the system. These are private companies that must be accountable to shareholders.

That means they MUST make money. This has been the case since the 1970s and at the expense of the patient and provider. Remove the necessity to make corporate profits off of health care and that money can be used to PROVIDE HEALTH CARE. Further, the costs would plummet since there would be NO health insurance premiums, no costly utilization review, no denial of health care, no delay of obtaining health care, no fighting for reimbursement, all of which costs billions. Further, denial often times ends in death, and delay ends up costing more than if treatment were authorized when requested. Remove all this nonsense, and we would all be healthier and health care costs would be significantly reduced.

Remember, health insurance companies DO NOT PROVIDE HEALTH CARE. They broker health care which is a nice way of saying they are pimps for executives and shareholders.

Tort reform should also drive down some of the cost and needs to be looked at carefully. There is not a lot of evidence showing that tort reform will reduce mal practice insurance premiums. Again, the insurance companies must make a profit and they will sell anything at the highest price they can get. No regulation is equal to highway robbery for the insurance industry. Only competition will drive down the costs of mal practice insurance.

The result of removing corporations from the health care system would be a single payor system in the USA. We are the only industrialized country in the world that does NOT have this for all of their citizens. Personally, I think that is shameful that people go bankrupt because one major illness cost them their life savings and assets in the wealthiest industrialized country in the world. This is ONLY because corporations must make a profit on health care.

Should be an interesting next couple of weeks. The senate finance committee should have legislation ready to present to the senate in a few days. I just hope our president has the balls to stand up to special interest, conservative democrats, and republicans on this issue.

Protect the Insurance Companies

2009-09-22T16:25:00.000-07:00

Must see video. Enjoy

http://www.funnyordie.com/videos/041b5acaf5/protect-insurance-companies-psa

Study links 45, 000 U.S. deaths to lack of insurance

2009-09-18T10:11:00.000-07:00

WASHINGTON (Reuters) – Nearly 45,000 people die in the United States eachyear -- one every 12 minutes -- in large part because they lack healthinsurance and can not get good care, Harvard Medical School researchersfound in an analysis released on Thursday."We're losing more Americans every day because of inaction ... than drunkdriving and homicide combined,"

Dr. David Himmelstein, a co-author of thestudy and an associate professor of medicine at Harvard, said in aninterview with Reuters.Overall, researchers said American adults age 64 and younger who lack healthinsurance have a 40 percent higher risk of death than those who havecoverage.

The findings come amid a fierce debate over Democrats' efforts to reform the nation's $2.5 trillion U.S. healthcare industry by expanding coverage and reducing healthcare costs. President Barack Obama has made the overhaul a top domestic policy priority, but his plan has been besieged by critics and slowed by intense political battles in Congress, with the insurance and healthcare industries fighting some parts of the plan.

The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or "single-payer" health insurance.

A similar study in 1993 found those without insurance had a 25 percentgreater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage. Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.

Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said. Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.

Some critics called the study flawed. The National Center for Policy Analysis, a Washington think tank that backs a free-market approach to health care, said researchers overstated the death risk and did not track how long subjects were uninsured. Woolhandler said that while Physicians for a National Health Program supports government-backed coverage, the Harvard study's six researchers closely followed the methodology used in the 1993 study conducted by researchers in the federal government as well as the University of Rochester in New York.

The Harvard researchers analyzed data on about 9,000 patients tracked by the U.S. Centers for Disease Control and Prevention's National Center for HealthStatistics through the year 2000. They excluded older Americans because those aged 65 or older are covered by the U.S. Medicare insurance program."For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health careis supposed to prevent," said Woolhandler, a professor of medicine atHarvard and a primary care physician in Cambridge, Massachusetts.

We're number 37

2009-09-16T11:55:00.000-07:00

Wealthiest nation in the world but only 37 on the World Health Organizations List of best health care. Check it out

http://www.youtube.com/watch?v=yVgOl3cETb4

The Health Insurance Racket: Getting Rich by Denying Care

2009-09-15T16:53:00.000-07:00

As previously discussed, health insurance companies profit by denying or delaying care. People who have paid insurance premiums do NOT get the care they need. This is why a public option must be part of Health Care reform. Write or call your congresspersons and senators. This is the most important issue of our time. Get active and do something about it. Visit www.sickforprofit.com to watch video and make sure you share it with your family and friends.

Employer based Health Insurance: A major source of anxiety

2009-09-10T08:43:00.000-07:00

The Secretary of Health and Human Services is releasing a new report today that shows significant insecurity among workers who receive health insurance through their employers. "Millions of Americans depend on their job for health benefits, but more and more of these families have seen their coverage disappear," writes Jeanne Lambrew, Director, HHS Office of Health Reform.

The Secretary's report notes that "A full one in six Americans with employer-sponsored insurance in 2006 lost that coverage by 2008." This fact is extremely important when you consider 9.75% national unemployment rate. When people lose their jobs, they lose their family health insurance and must seek alternative coverage. Since there are very few insurance company options, and since the insurance companies are motivated by profit, obtaining health insurance for their family costs 60% more than employer funded plans in out of pocket costs for deductibles and co-payments. The report further reveals that almost 75 percent of individuals looking for coverage on the individual market never bought a plan, with 61 percent of those who did not purchase the insurance citing premium cost as the primary reason. This is the health insurance company's way of kicking a person while they are down.

Please visit www.HealthReform.gov and read the complete report. It’s a powerful argument in favor of real reform that will give American families the security and stability they require.

Last night, President Obama spoke to our nation about his health care plan. He pointed out the necessity for reform and attempted to dispel the fictitious ramblings and misinformation generated by Health Care NOW opposition. The opposition will NOT STOP it's effort to defeat Health Care Reform. There is too much money at stake and too much special interest influence to stop the lies, hate mongering, and craziness expressed by the opposition. We, THE PEOPLE, must take responsibility to ensure Health Care NOW. This is a critical time and we are closer to health insurance reform than ever before. Please call, write, or email, your Senators and Congressperson and demand support for Health Care Reform. With your involvement and support, we will make Health Care NOW a reality.

Health Care Reform: The Assault on Truth

2009-09-09T16:39:00.000-07:00

The following article is from AARP Bulletin Today published on August 14, 2009. In less than an hour, President Obama will speak to the nation on Health Care Reform. He will try to dispell the myths and misinformation presented by Health Care Reform opposition, primarily funded by the insrucance industry, pharmaceutical industry, and others who benefit from the status quo. Thank you Ms Barry for attempting to get at the TRUTH

By Patricia Barry:

Now it’s getting down and dirty. As expected, the gloves are off in President Obama’s push for health care reform. Democrats and Republicans are battling over how to fix a system they all agree is broken—that’s how Congress is supposed to work. But this summer something new has entered the political arena—a tsunami of rumors, myths, fear-mongering and misinformation about the proposals that surges around the Internet in nanoseconds. “I’m totally confused about what’s going on,” one reader wrote to the AARP Bulletin. “How do I know who to believe?”
Misinformation spreads at rapid speed

It’s a good question. Another is how this new phenomenon—the ability to spread misleading information at rapid speed through chain e-mails, blogs, text-messaging and “tweets”—will affect the reform debate.

“What we’re seeing is a flood of viral content that distorts the Obama effort to reform health care,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, who codirects www.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum.

Today’s opposition tools are very different from those used against previous attempts at health care reform in the Clinton era. Then, the key means of attack available were television advertising and direct-mail campaigns, which were expensive and took time to organize.
“Extremists and people who are so locked into their own ideology that they’ll distort anything have been out there forever,” Jamieson says. “But they haven’t had a way to reach out to as many people as efficiently as they have now.”

Understanding the proposals

Health care reform has “serious consequences to people’s lives, and it would be useful if as many people as possible actually understood what the proposals are about,” Jamieson says. But the rise of the Internet and the decline of the mainstream press as a prime source of information, she adds, put that prospect at risk.

To add to the confusion, Obama, while talking up his overall goals for reform, has left it to Congress to work out the details. The result: a number of committees, each developing and announcing scores of proposals, which change as negotiations progress. “This process has not been a success in garnering public support for reform, and has left people nervous,” says Robert Blendon, professor of health policy and political analysis at Harvard University’s School of Public Health. “So the headlines every day, because the bills are different, scare different people.”
Could the rumormongering affect the outcome? Recent angry exchanges and violent interruptions at lawmakers’ town hall meetings during the August recess suggest that it might. Members of Congress faced a barrage of questions based on the same Internet-spread myths.
If a disproportionate number of constituents who believe the rumors show up at meetings, while those who are happy with health reform stay home, what then? “Does that skew the member’s sense of public opinion?” Jamieson asks. “Does it send the member back [to Washington] saying, ‘I’m going to lose the election if I vote for this thing?’ ”

Blendon, though, thinks most voters, especially the independents, ultimately won’t be swayed by the myths. “The real debate for them is: What happens to me and my family out of this thing?” he says.

As proposals are refined into a single bill, which could happen this fall, Americans will get a better handle on what matters to them—whether their own health care costs would rise or fall under reform, whether taxes would increase to pay for it, and what impact it would have on the deficit, Blendon says.

Meanwhile, here are some of the persistent myths about health care reform, how they arose, and what the three leading current proposals—a House bill, a Senate health committee bill and a set of options still being considered by the Senate Finance Committee—actually say about those issues:

Q. Will the government take over health care so we end up with socialized medicine?

No. Neither the president nor the congressional committees have suggested anything remotely resembling a government takeover of health care.
Obama has specifically rejected the idea of a “single payer” system, like Canada’s, in which the government insures all citizens. None of the leading proposals in Congress even considers going down this road—a fact that has brought strong protests from some consumer and doctor groups that favor this approach. And although Sen. Edward Kennedy, D-Mass., has long called for a “Medicare for All” program, this is not included in proposals from the Senate health committee that he chairs.

Even further off the table is the concept of “socialized medicine”—in which the government not only runs health care but also owns hospitals and pays doctors’ salaries. Great Britain has this kind of setup, as do the Veterans Affairs and Department of Defense health programs in the United States.

Where did this myth come from? Opponents of reform constantly use the term “government-run health care” to disparage the reform proposals, despite the popularity and success of existing government-run programs like Medicare. The tactic often works. Even some Medicare beneficiaries say they’re worried about a “government takeover” of Medicare.
What do the proposals say? Obama has proposed setting up a single “public plan”—available only to those without employer insurance—to provide a voluntary alternative to the many private plans that offer individual health insurance. The House and Senate health committee bills propose a national public plan to compete with these plans and meet the same requirements. The Senate Finance Committee is expected to exclude a public plan. Lawmakers are also considering state-run community health co-ops as an option.

Q. Will private insurance be outlawed or wither on the vine?

No. Obama and the congressional committees say their objective is to build on the current system—keeping employer-sponsored group insurance and giving more consumer protections to people who are employed by small businesses or buy insurance as individuals.
Supporters of a public plan option argue that it would act as a safety net for the uninsured, provide competition for private insurers and, in Obama’s words, “keep them honest.” Opponents of the public option, including the health insurance industry, contend that it would ultimately destroy private insurance because the government could offer lower payment rates to doctors and hospitals, as Medicare now does.

Where did this myth come from? Currently 177 million people have employer or individual insurance. The issue caught fire after the Lewin Group, a research consulting firm owned by UnitedHealth Group, estimated that 119 million of them would switch to a public plan, if everybody were allowed to join it. But the proposals actually exclude those with employer insurance from the public plan. On that basis, the group estimates that 34.9 million would exit private insurance—but it was the high 119 million figure that ricocheted around the Internet.
Another public policy group, the Urban Institute, calculated that after reform, 161 million (or 91 percent) would still enroll in private plans. A third group, the Economic Policy Institute, examined how employers would react to a “pay or play” mandate, which would require them to either provide coverage or contribute up to 8 percent of payroll to cover the uninsured. Fears of a mass exodus from employer insurance “are overblown,” the study found. “Millions of workers will keep the employer-sponsored insurance they have today.”

What do the proposals say? Each of the proposals calls for national or regional heath insurance exchanges that would allow people without employer or public insurance and small employers to choose from a menu of private insurance plans (and a public option, if there is one), with online information to help compare them.

Subsidies would be available for people unable to afford the premiums, on a sliding scale according to income. And under the House bill, people with employer insurance would be eligible for government help if their premiums exceeded 11 percent of their income. Small businesses would also get subsidies.

People with existing insurance would be able to keep it after reform begins. But after that date, new individual policies could no longer be sold unless they met required standards of benefits. After five years, all plans—including group employer insurance—would have to meet those standards.

Q. Will the government encourage euthanasia to save costs?

No. This false but scary idea—now surging around the Internet in blogs and e-mails—claims that the House bill would require Medicare beneficiaries to have mandatory classes every five years to decide how to end their lives earlier. Typical e-mails add: “They’re going to push suicide to cut Medicare spending!” All identify page 425 of the bill as their source.

Where did this myth come from? On July 16, Betsy McCaughey, a former Republican lieutenant governor of New York, appeared on a conservative radio show. Citing page 425, she said: “Congress would make it mandatory … that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner … all to do what’s in society’s best interest.”

On July 23, Rep. John Boehner of Ohio, leader of the House Republicans, issued a statement saying: “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.” On Aug. 7, former Alaska governor Sarah Palin described the proposal as setting up a “death panel.”

What does the proposal say? The clause on page 424 (section 1233) would require Medicare to pay doctors for their time if beneficiaries chose to consult them for information on advance care planning, such as making a living will, appointing a health proxy, and hospice care (already covered by Medicare). Medicare would pay for these sessions only once every five years.
AARP described McCaughey’s claims as “rife with gross—and even cruel—distortions” of legislation that “would not only help people make the best decisions for themselves [on end-of-life care], but also better ensure that their wishes are followed.”

Republican Sen. Johnny Isakson of Georgia, who has sponsored a bill that would also allow Medicare to cover end-of-life planning, characterized the death panel talk as “nuts.”
Q. Will Medicare be eliminated or gutted to pay for reform?
No. It’s inconceivable that any lawmaker would commit political suicide by proposing to get rid of Medicare. But the rumor has fast gained ground.

Where did this myth come from? Dick Morris, a political commentator, posted an article on his blog that began: “Obama’s health care proposal is, in effect, the repeal of the Medicare program as we know it.” Morris claimed that the proposals “will totally gut Medicare and replace it with government-managed care and rationing.” His article was picked up within days on some 281,000 websites.

What do the proposals say? It’s true they all seek to save billions from Medicare costs—not by cutting benefits, but by setting up new ways to pay doctors more fairly and to reward providers for quality of care instead of (as now) paying them a fee for each separate service; reducing waste and fraud; and reducing preventable hospital readmissions.

All the proposals would cut the amount of subsidies now paid to Medicare Advantage private health plans, which cost an average of 14 percent more per person than traditional Medicare does. Without subsidies, the private plans could become more efficient, or they could raise premiums, reduce benefits or withdraw from Medicare.

The proposals also add benefits to Medicare—such as covering more preventive services and narrowing the Part D “doughnut hole.”

Q. Will the government ration care?

No. But the specter of “rationing” is the battle cry of reform opponents. They say people in their 90s, 80s or even 70s will be deemed “too old” for joint replacements and cancer care—and even, in one persistent rumor, that “Obamacare” would deny treatment to people going blind in one eye as long as their other eye still works.

Where did this myth come from? It’s part of the “government takeover” argument, playing on often inaccurate beliefs that countries with national health systems severely ration care. In a widely circulated memo, political consultant Frank Luntz offered Republicans language that he believed would most resonate with Americans to defeat the Democrats’ push for reform. He suggested they say: “In countries with government run healthcare, politicians make your healthcare decisions. They decide if you’ll get the procedure you need … We can’t have that in America.”

What do the proposals say? In fact, they seek to prevent denial of care. Under every proposal, insurance companies would no longer be able to deny coverage on the basis of current health or preexisting medical conditions.

The proposals also would require plans to offer benefits packages with a comprehensive range of medical services equal to those in typical employer-sponsored plans. An independent advisory board, removed from political influence, would recommend new specific services to be covered based on scientific evidence. Annual or lifetime limits on coverage would be prohibited. None of the bills places any age limits on receiving medical care.
Where to go for the facts on health care reform proposals:

The following websites are run by nonpartisan organizations with no stake in the proposals:
The Kaiser Family Foundation's side-by-side comparison of the details of the leading proposals
The Annenberg Public Policy Center's fact checker
Politifact.com's Truth-O-Meter

Six health insurance executives could provide health care for 30,000 families

2009-09-09T10:32:00.000-07:00

THE FOLLOWING SIX EXECUTIVE COMPENSATION PACKAGES COULD PROVIDE HEALTH CARE FOR 30,000 AMERICAN FAMILIES. I AM NOT OPPOSED TO PEOPLE MAKING VERY GOOD LIVINGS. I AM OPPOSED TO MAKING A VERY GOOD LIVING BY DEPRIVING LESS FORTUNATE PEOPLE HEALTH CARE. THESE COMPENSATION PACKAGES ARE FUNDED BY DENYING TREATMENT, DELAYING TREATMENT, AND IN MANY CASES TERMINATING HEALTH INSURANCE WHEN A CLAIM IS MADE AFTER YEARS OF PAYING PREMIUMS. FOR ADDITIONAL INFORMATION visit http://sickforprofit.com/

UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)

CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday. (Oakland Tribune)
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year. (USA Today)

Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)

Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (USA Today)

Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500

WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700

Health Care NOW: Historical or Hysterical?

2009-09-08T16:06:00.000-07:00

MEDSCAPE Article on Health Care Refor Debate

August 31, 2009 — The healthcare-reform debate boggles the mind, whether it's the trillions of dollars at stake, the thousands of pages of legislation cranked out by Congress, or the superheated rhetoric in townhall meetings. How did the subject of insurance coverage for all morph into euthanasia?

Then again, with healthcare amounting to a cradle-to-grave issue for every individual and accounting for almost 18% of the economy, it is not surprising the current debate has taken on historic, if not hysterical, proportions.

The role played by physicians, too, is historic. Organized medicine has traditionally opposed government intervention in healthcare, but the first full-blown piece of reform legislation to emerge — HR 3200 in the House — has won the support, albeit qualified, of the American Medical Association (AMA), the American College of Physicians (APC), the American Academy of Family Physicians (AAFP), the American College of Surgeons (ACS), the American Osteopathic Association, the American College of Obstetricians and Gynecologists, and other medical organizations.

Contrary to what many of their constituents believe, these organizations assert that the proposal to extend coverage to the uninsured, partly through a controversial government-run plan, and to more tightly regulate private insurers doesn't represent the bogeyman of socialized medicine. They also argue that the bill benefits physicians, primarily by scrapping the Sustainable Growth Rate (SGR) formula for setting Medicare pay and averting a 21.5% across-the-board cut next January.

"If you come to 2010 without fixing the SGR, this would have a catastrophic affect on primary care and other specialties," said ACP president Joseph Stubbs, MD, from Albany, Georgia.
HR 3200, the product of 3 House committees, is only a rough draft of reform for Congress, which reconvenes in September after summer recess. The House committees will continue refining HR 3200 while Senate committees craft their own bills; these will eventually be merged.
The House and Senate will then vote on their respective unified bills, which, if approved, would need to be reconciled so an identical bill would go to each legislative body for a final vote. Although HR 3200 might not exactly resemble the end product, it nevertheless provides a good look at the bullet points of the healthcare-reform debate of 2009.

All But 3% of Legal Residents Would Have Coverage

The centerpiece of HR 3200, dubbed America's Affordable Health Choices Act, is the Health Insurance Exchange. It is a marketplace in which individuals, families, and small businesses with annual payrolls not exceeding $250,000 will be able to shop for insurance plans, and which will include a "public option" operated by the government (this plan might be taken off the drawing board, though — more on that later).

Cash-strapped individuals and families would receive "affordability credits" on the basis of income, and small businesses would receive tax credits toward purchasing coverage. In contrast, larger businesses are obliged to "play or pay" — either provide coverage for employees or pay into a fund to finance coverage through the exchange.

All individuals are required to obtain coverage through their employer or the exchange, or they will have to pay a penalty. If they already have coverage through an employer or an individual policy, they can keep it, although grandfathered employer-sponsored plans must satisfy the bill's requirements by 2018. Meanwhile, the bill would expand Medicaid eligibility, bringing 11 million more people into the program by 2019, according to the Congressional Budget Office (CBO).
HR 3200 also rewrites the terms of insurance coverage, authorizing a minimum menu of benefits — including preventive services with no cost sharing — that will be a template for all plans offered through the exchange and, eventually, those available from large employers. Health insurers would be prohibited from denying coverage on the basis of an individual's preexisting conditions or dropping coverage for sick individuals (except if they have perpetrated a fraud). Furthermore, they could charge premiums only on the basis of age, geography, and family size — not health status or sex.

The CBO estimates that the bill would reduce the number of uninsured from a projected 51 million in 2010 to 17 million in 2019, 9 million of whom would be illegal immigrants who wouldn't be eligible for premium subsidies. In effect, 97% of legal residents would become insured.

Competition Enhancer or Killer?
The public-option plan is designed to give individuals and small businesses an alternative to private insurers, especially in markets where 1 or 2 companies dominate.
"It would be nice to see some competition," said William Jessee, MD, president and CEO of the Medical Group Management Association, which has not taken a position on HR 3200. "Membership satisfaction with Medicare is very high, so the idea of having another government-operated program doesn't frighten me. It would push private insurers to pay more accurately and promptly."

However, other physicians, such as former AMA president and general and vascular surgeon Donald Palmisano, MD, view the public option as the Trojan horse that would usher in a government-run single-payer system by unfairly squeezing out private insurers. "Having the government for a competitor is like playing against a football team that's doubling as the referee," said Dr. Palmisano, a spokesperson for a group called the Coalition to Protect Patient Rights. "It will move the goal posts when you're ready to kick a field goal."
Such fears strike Stanford University economist Alain Enthoven, PhD, as realistic. By paying providers based on the Medicare rates, the public-option plan would enjoy a cost advantage over private insurers and their higher rates, said Dr. Enthoven, who authored the concept of "managed competition" that figured into the failed healthcare-reform proposal of the Clinton administration. And although HR 3200 stipulates that the public option is to be financed strictly through premiums, Dr. Enthoven expects that Congress would eventually allocate tax dollars.
"It strains credulity to suggest that the public plan wouldn't be unfairly subsidized," Dr. Enthoven said, noting that "some of the enthusiasts for the public option admit offline that its purpose is to drive private insurers out of business."
Various groups have attempted to precisely calculate the impact of a public plan on private insurance. The CBO projects that the number of privately insured Americans would increase 9% through 2019, to 161 million, under HR 3200, even as enrollment in the public plan reaches 11 to 12 million.

The nonpartisan Urban Institute forecasts a 9% drop in the number of privately insured during this time if a public plan materializes. Perhaps the most negative assessment comes from the Lewin Group, a consulting firm owned by health insurer UnitedHealth Group. It predicts that the public plan under HR 3200 would cover 34 million Americans by 2019, while the number of privately insured would decrease 20%, to 138 million, if eligibility for the public plan is limited to small firms. If it is extended to larger employers — something the bill permits — public-plan enrollment would grow to 103 million while private-plan enrollment would shrink 48%, to 89 million.

With the public plan drawing flak, President Obama and lawmakers have suggested that they might replace this component of healthcare reform with regional or state-wide health-insurance cooperatives, akin to those in rural America that provide electricity or water. A few such cooperatives already exist in healthcare — witness the Seattle-based Group Health Cooperative — but expert opinion is mixed as to whether these member-owned organizations would be large enough to negotiate favorable rates with hospitals and physicians and compete effectively with private insurers.

What HR 3200 Does for Medicine
A healthcare system with more insured patients will need more primary-care physicians to treat them, and HR 3200 attempts to put more in the pipeline. Among other things, the legislation boosts funding for the National Health Services Corps, which finances a doctor's medical training in exchange for working in underserved areas, and creates other grant and loan programs for primary-care trainees.

The bill also tries to improve physician compensation, especially for primary-care doctors. The legislation eliminates that the much-maligned SGR formula for Medicare would have subjected physicians to an overall 21.5% cut in 2010.
Pegged to changes in the gross domestic product (GDP), the SGR sets a target for Medicare expenditures on physician services each year, and if actual expenditures exceed the target, physicians face a corresponding pay cut the following year.
Physicians complain that the SGR underestimates healthcare inflation and the way it affects their own costs. Since 2002, spending on physician services has regularly overshot the targets, triggering cuts. And year after year, Congress has cancelled scheduled reductions in response to physician outcry, but the SGR "debt" continues to accumulate, topping $300 billion as of last December, according to the CBO. This mounting debt makes future reductions even deeper.

In a single stroke, HR 3200 would eliminate the scheduled cut for 2010 by erasing the accumulated SGR debt from the books. Instead, Medicare would raise its rates next year based on its estimate of inflation in physician-practice costs. By averting a compensation train wreck in Medicare, the bill also would forestall reductions by private insurers, noted Dallas general surgeon John Preskitt, MD, who sits on the ACS Board of Regents. "Some plans base their rates on Medicare's."

Gradual Rise in Woefully Low Medicaid Fees

Beginning in 2011, a new formula kicks in, creating 2 separate spending targets for physician services under Medicare. One target is based on GDP plus 2% or evaluation and management services and preventive care — a nod to cognitive-oriented primary-care doctors — and the other on GDP plus 1% for all other physician services.
This break for primary care in the revamped formula is just 1 way in which HR 3200 attempts to attract more trainees to this field and avert a workforce shortage. The bill boosts Medicare rates for primary-care physicians by an additional 5% — 10% for those in medically underserved areas. And the woefully low fees they receive from Medicaid would gradually be raised to Medicare levels.

In addition, the government would spend more money to experiment with new ways to deliver care — such as patient-centered medical homes and accountable care organizations — that would reimburse physicians on the basis of quality and cost-effectiveness, concepts foreign to the fee-for-service model.

A number of leaders in organized medicine view such "pay-for-performance" arrangements as the ultimate cure for the Medicare pay problem, relieving doctors of the need to perform more and more services to make up for shrinking reimbursement.
"We're looking for a value-based system, not a volume-based system," said Philadelphia cardiologist Alfred Bove, MD, president of the American College of Cardiology.

Is Healthcare Reform Affordable?

With the federal deficit projected to hit $1.6 trillion in 2009, and anywhere from $7 trillion to $9 trillion through 2019, proposals to overhaul the healthcare system must convince budget hawks that they pass the affordability test. The CBO estimates that HR 3200 will add $239 billion to the deficit through 2019 after new revenues and cost savings in Medicaid and Medicare are subtracted from outlays.
Significantly, CBO director Douglas Elmendorf told Congress that he saw nothing in the bill that would fundamentally bend the cost of healthcare downward. Likewise, a competing healthcare-reform bill from the Senate Committee on Health, Education, Labor, and Pensions would produce roughly $1 trillion in red ink during that period, according to the CBO.

To Dr. Joseph Stubbs of the ACP, HR 3200 essentially pays for itself, as opposed to increasing the federal deficit, if one subtracts the cost of retiring the accumulated SGR debt in Medicare — a position taken by some House Democrats.
In addition, Dr. Stubbs said the CBO did not factor in potential cost savings from new healthcare-delivery models, such as the medical home, which could save $175 billion over 10 years through improved coordination of care.

Myths Abound

Critics of HR 3200 have raised a blizzard of objections, some fact-based and some far-fetched. Take the assertion, for example, that the bill authorizes bureaucratic "death panels" that will ration care and promote euthanasia. It arose from a provision on reimbursing physicians for counseling patients about hospices, palliative care, and other end-of-life issues — a provision applauded by none other than the gray-haired American Association of Retired Persons.
"People who receive this kind of counseling feel better about the choices they make," said Dr. Stubbs, adding that "it's all voluntary."

Groups including the ACP and the AAFP recently issued a joint statement rebutting the "death panel" myth, along with several dozen others, among them the notions that free healthcare would be extended to illegal aliens, that the government would gain access to all financial and personal records of citizens, and that the bill would subsidize abortions.

"It's a sad commentary that the public debate has become fueled by misinformation," said Dr. Jessee of the Medical Group Management Association. "Some of it is innocent; some of it is intentional, I think. It's also a commentary on how complex the issue is and how much our citizenry would like to have a simple solution."

Journalist
Robert Lowes
is a freelance writer for Medscape.

$400,000,000 Spent on Influencing Health Care NOW

2009-09-08T15:02:00.000-07:00

Health care lobbying: Political power machineLobbying. TV ads. Political donations. Nearly $400 million has already been spent to influence the debate - the most expensive fight ever to hit Congress.By Jennifer Liberto, CNNMoney.com senior writerWASHINGTON (CNNMoney.com) -- The fight over health care overhaul is on track to be the most expensive issue ever to hit the hallways of Congress.The bill for lobbyists, television ads and political donations has topped $375 million -- or enough to pay the entire insurance tab for about 30,000 families a year.The big spenders range from drug companies, hospitals and doctor groups to organizations that advocate for unions, immigrants and retirees.The largest chunk has gone to direct lobbying of lawmakers and other policymakers. In the first half of 2009, the health care industry spent nearly $280 million on lobbyists, according to the Center for Responsive Politics.Another $75 million was spent on television advertising airtime by health care interests, mostly politically left-leaning groups and health industries. And another $23 million has flowed from the health care sector into the campaign war chests of 2010 candidates for federal office, on the heels of some $95 million raised during the 2008 cycle."The health sector is on track in 2009 to spend more on lobbying than it has on any other year in U.S. history -- and by a lot," said Dave Levinthal of the Center for Responsive Politics, which analyzes and collects lobbying and campaign spending figures.

Congressman Thompson Responds to Fear and Ignorance

2009-09-08T10:41:00.000-07:00

Following is a letter from Northern California Congressman MikeThompson in response to his constituents expressions of concerns and misinformation regarding Health Care REFORM. The name of the person receiving this letter was removed for privacy. The content of the letter is very informative and helps set the record straight.

Dear Constituent:

I have a keen interest in healthcare, both as an individual and as a public servant. My wife Jan is a full-time nurse practitioner in our district and was a hospice nurse for years. I've had government sponsored healthcare in the Army - both here and overseas - and private healthcare with Kaiser Permanente and Blue Cross Blue Shield. Over the years, as a State Senator and U.S. Representative, I've talked with thousands of Northern Californians at length about the times when healthcare has been a blessing and, unfortunately, when it's failed them.

<>
I first ran for office in 1990, and a big part of that decision was because of the challenges of healthcare policy and its importance. This issue has remained in the forefront of my attention ever since. In the State Senate, I passed legislation that required all group healthcare plans to provide preventive healthcare to children, improved healthcare policies in rural areas and supported the development of telemedicine. Since arriving in the House of Representatives, I continued this work by enacting legislation that waives co-pays for colonoscopies and mammograms for Medicare beneficiaries, helps doctors who are called away to service in the reserves or the National Guard, expands telehealth technology, reverses harmful cuts to Medicare reimbursement rates for physicians, promotes funding for rural clinics and addresses unfair geographic reimbursement policies that consistently underpay providers in our district. <>

Unfortunately, many problems like rising premiums, shortages of skilled healthcare workers and a deteriorating long-term fiscal outlook for programs like Medicare have grown worse. These issues are far larger, more complex and more pervasive than almost any others our nation faces. It is no surprise that they have also drawn the most passionate responses. <>

Some argue that any type of reform would lead to socialism, but the majority of constituents I've heard from want Congress to lower costs, provide access for everyone and improve the quality of care. Most opinions are heartfelt, but a few are startling, such as the writers who want to reject any government involvement in healthcare because it's "socialist" while they themselves are receiving healthcare through Medicare or the Veterans Administration. However, almost every person I talk to or hear from agrees - the current healthcare system needs to be fixed. <>

While I am a strong proponent of healthcare reform, we need to make sure that we do this right. As you no doubt know, our current healthcare system is not sustainable. In the last 15 years, healthcare spending has jumped 145% to over $2.24 trillion. This is the equivalence of one in every $6 we earn going for healthcare. At current rates, within a decade that figure is expected to rise to one in $5, and within 30 years it will be one out of every $3. Right now, this system is failing us all; from those who can't get insurance because of a pre-existing condition to the families that have coverage but are finding it harder and harder to afford their rising premiums and deductibles. We are on an unsustainable path and most Americans want this corrected.
The House of Representatives is now considering the America's Affordable Health Choices Act (H.R. 3200), which presents comprehensive solutions to the healthcare challenges faced by all Americans. This bill includes many of my priorities, such as:

o Better healthcare for everyone by requiring all plans to meet minimum benefits standards, prohibiting denials of coverage based on pre-existing conditions and eliminating co-payments for preventive care visits to a doctor;

o Strengthening Medicare by increasing reimbursement rates for Medicare providers to allow them to continue seeing Medicare patients and closing the "donut" hole in prescription coverage for Medicare Part D;

o Real choice in a health insurance marketplace where consumers can compare different plans, including a public plan option, while still retaining the freedom to keep their current doctor, hospital and plan if they choose;

o Ensuring access to healthcare in rural areas by providing a reimbursement increase to primary care physicians practicing in these communities and expanding telemedicine services to make specialized care available for patients in underserved areas.

As a member of the Ways and Means Committee, I helped write parts of this bill, and I know that there is a lot in the bill that will go far toward improving our system. Although the full House of Representatives will not consider H.R. 3200 until September, I voted for this important legislation when it was considered by the Ways and Means Committee on July 17. We needed to advance this bill so that we can continue the work of crafting a comprehensive plan that will fix our healthcare system.

<> However, it is important to remember that this is the beginning of the process, and there is much work that remains to be done in both houses of Congress before we will reach a final bill. Nevertheless, there is wide agreement that the final version must satisfy these principles:

o Reduce the long-term growth of healthcare costs;

o Provide a choice of doctors and health plans;

o Improve quality of care and invest in prevention and wellness; and,

o Ensure affordable healthcare for all Americans.

Currently there are five bills in Congress to reform healthcare, three in the House and two in the Senate. From these, members of the House and Senate will reconcile differences, make improvements and come up with an even better bill. I think we have a long way to go before we are where we need to be, but H.R. 3200 is an important first step.

<> Healthcare touches all of our lives in a very personal way. I absolutely understand why so many Americans are concerned about the effectiveness and cost of healthcare. That's why it's so important that you judge the facts of this bill for yourself, particularly when there's been much disinformation. I have attached answers to the most common questions my office has been receiving for your review. Additionally, you can go to the Ways and Means Committee website (waysandmeans.house.gov) to read the bill in its entirety as well as a section-by-section summary. I will continue to update you as this important legislation progresses.

Question: Has Congressman Thompson read the bill?
Answer: I have read and was involved in drafting the bill I voted on. For weeks before the introduction of H.R. 3200, members of the Ways and Means Committee, myself included, met daily to go through the bill line by line and section by section. As a group, we spent 86 hours going over this legislation.

Question: Will health reform force all Americans out of their private insurance plans and into a one-size-fits-all government plan?

Answer: No. H.R. 3200 builds on the current system of employer-based coverage, it doesn't replace it. If you are happy with your current plan, you can keep it. H.R. 3200 includes a public plan that individuals will have the option of purchasing, along with a variety of other private plans. This public plan will be required to be financially self-sustaining, as private plans are, covering its costs through premiums and co-pays.

Question: Does page 16 of the bill require me to join the public plan if I lose my private insurance coverage?

Answer: No one will be required to join the public plan. If you lose your insurance, you will be able to shop for a new plan at an online exchange that includes information on all insurance options. This exchange will bring together information that is currently scattered giving consumers the opportunity to quickly and effectively compare plans to make informed decisions about what coverage works best for them. The provision on page 16 merely requires individuals joining a private insurance plan after 2013 to do so through the exchange.

Question: Are Members of Congress exempt from changes that are being proposed for the rest of the country?

Answer: No. Members of Congress receive the same healthcare options as other federal employees, with a choice of plans from private insurers that vary by benefits, premiums and co-pays. This legislation would affect federal employees in the same ways that it affects everyone else who gets their health insurance through their employer.

Question: Does this bill cover illegal immigrants?

Answer: No. Section 246 of H.R. 3200 explicitly prohibits the payment of affordability credits designed to help low and moderate incomes families purchase insurance to anyone who is not lawfully present in the United States.

Question: Does this bill require seniors to attend mandatory counseling sessions on euthanasia?

Answer: No. H.R. 3200 states that Medicare will reimburse doctors and nurse practitioners for a counseling session with Medicare beneficiaries regarding advanced care planning. This consultation includes a discussion of laws and options regarding living wills, the roles and responsibilities of a health care proxy and other planning resources that may be available for the individual. These consultations are strictly voluntary.

Question: Will all small businesses be forced to provide coverage to their employees?

Answer: This bill exempts small businesses with a payroll of less than $250,000 from the requirement to provide health insurance for their workers. Businesses with payrolls above $250,000 that do not provide coverage will be assessed a charge that will gradually increase with the size of their payroll. The current version of the bill has this charge starting at 2% for payrolls above $250,000 and increase to a maximum of 8% for payrolls above $400,000. These revenues will go to offset the cost of coverage for individuals purchasing insurance through the exchange. Small businesses that opt to offer insurance will receive tax credits to offset the cost of insurance.

Question: What does this bill do to stop fraud and abuse in Medicare?

Answer: This bill strengthens existing compliance and enforcement tools for Medicare, increases funding to support these efforts and creates new, tougher penalties for individuals who submit false claims or applications to Medicare. The Congressional Budget Office (CBO) has estimated that every $1 we invest in fighting waste, fraud and abuse will yield $1.75 in savings.

Question: Can our nation afford healthcare reform?

Answer: The truth is that the rising cost of healthcare for all Americans is a problem that will not fix itself and that we can't afford to not address. Today, we spend one out of every $6 we earn on healthcare. If we don't take action to slow the increase in costs, within a decade we will spend one out of every $5 on healthcare, and within 30 years this will rise to one in every $3. These facts make it clear, the longer we wait, the more it will cost to fix our broken healthcare system.

Question: How much will this bill cost?

Answer: There is no question that there will be significant costs to implement this legislation. The CBO's latest estimate puts the price tag at $1.042 trillion over ten years. Here is how we are going to pay for the bill. First, we are going to address inefficiencies in Medicare and Medicaid and crack down on fraud, waste and abuse in these programs to save $465 billion over the next ten years. Second, we will need to raise $583 billion in revenues to cover the rest of the cost. The Ways and Means Committee proposes to do this through a surcharge on the wealthiest 1.2% of income earners, who have enjoyed a tremendous advantage for the last eight years because of the Bush tax cuts (the average reduction in federal taxes for the top 1% in these tax cuts was $44,622). The Senate is considering other ways to raise these funds, and it is unclear how this issue will be dealt with in the final bill.

Question: Will this plan lead to rationing of healthcare? Will Congress be legislating what care my doctor can or must give me?

Answer: No. I believe that medical decisions should be left between patients and their doctors. Section 1401 explicitly forbids any studies or research called for in H.R. 3200 from being used to either mandate or deny care to a patient in any public or private plan. This research will gather data about what procedures are most effective to give doctors more information to consider when treating patients, not to replace your doctor's judgment with that of a bureaucrat from a private insurer or the government. The bill protects the ability of doctors to do what they think is necessary to help their patients without having to constantly worry about whether they will be reimbursed by an insurance company, which is why this bill has earned the strong support of the American Medical Association.

Question: Why is this bill being "rushed" through Congress?

Answer: Universal healthcare was first proposed by Teddy Roosevelt in 1912. President Harry Truman called for it in 1945. Former Representative John Dingell Sr. introduced a bill to provide universal healthcare in 1947 and his son, Representative John Dingell Jr., has reintroduced a bill every Congress since 1955. So, this is not a new issue and it was supported by both President Obama and Senator McCain in the November presidential election. There have been over 40 congressional hearings on healthcare reform since January. This particular legislation has been crafted, reviewed and revised repeatedly since the 111th Congress began, and it has been changed to reflect the considerable input from those in the healthcare community, members on both sides of the aisle and constituents. This bill is not being rushed - it is long overdue.

Sincerely,

MIKE THOMPSON
Member of Congress
http://www.mikethompson.house.gov

President addresses health care

2009-09-07T09:00:00.000-07:00

On Wednesday, President Obama will address our country on the issue of health care. It is incumbent upon all of us who have anything to say about health care in the United States to share our thoughts and concerns with the President. If he doesn't hear from us there is no way he will ever know how we feel about this extremely important issue. Health Care effects all of us. You can email president Obama at the following address.

http://capwiz.com/politicsol/mail/?id=3181&lvl=F&chamber=P

$1.2 Trillion waste in health care spending report

2009-09-03T12:24:00.000-07:00

As mentioned in earlier Blog, Price Waterhouse Cooper published a report revealing $1.2 trillion waste in health care spending. Following is a link to the report. It is very informative and easy to read. Enjoy

http://www.hasnet.us/uploads/PWC_The_Price_of_Excess_Exec_Sum_Exhibit3.pdf

Health Insurance a legalized scam?

2009-08-31T15:17:00.000-07:00

Following is an email I received from a person visiting Health Care NOW. I get many emails from Blog Readers but this one had to be shared. I think the following email represents the feelings of tens of millions of Americans. The person's name was omitted for privacy reasons.

Here are my observations,

When I was in New Zealand, I had my ACL broken in a baseball game. When I got back to the hotel, I noticed they had a hotel doctor. I called and requested his services. About 15 min. later the doctor arrived and evaluated my knee, told me what I was up against and offered suggestions on how to deal with it, including repairing it there in NZ. No charge and they have a national health care system.

While playing in Italy last year our catcher got hit in the ear from a bat swing. Someone drove him to the hospital where they immediately treated him, sewed him up with stitches, gave him drugs and a prescription. No charge and good immediate service.

A few days later our other catcher and 1st baseman collided foreheads at full speed chasing a pop up. Our catcher was minimally cut and the 1st baseman had his forehead cut open all the way from the left to right side of his forehead, very deep, past the flesh with lots of bleeding. We called and an ambulance came and picked them up and took them to a hospital. They spent two hours at the hospital. The catcher received 8 stitches above the eye and they stitched up the 1st baseman with many more stitches. They gave them both X-rays to make sure there was not other damage. They wrote up a report in english describing the entire procedure, what was done, suggested treatments and gave them copies of the X-rays. All this was so they could take it to their own doctors in the US. No charge and great immediate service as they have a natiional health care system.

When I needed to investigate my knee and head via an MRI last year, Blue Shield approved the one for the head but did not approve the one for the knee, despite multiple letters from my doctor. I had them both done anyway. Turns our there was nothing wrong with my head, fortunately, but there were lots of things wrong with my knee.

A while back my mother was very ill one morning. I called the Kaiser clinic who handles her medical care. They told me to call an ambulance and take her to a nearby hospital. The ambulance arrived and took her to the closest hospital, about 1/4 mile away. She stayed the night, had a couple of doctor visits, was attended to by the nurses and had some medications. Fortunately nothing was seriously wrong. Since she has Kaiser insurance and it was not a Kaiser hospital, it was several miles away, she later received a bill for $18,000. Does that seem excessive?

As an individual policy holder they keep raising my rates, this year they want to raise it to the tune of $700/mo. This seems outrageously high, especially if they are not going to cover various treatments and evaluations. I usually only have a couple of doctor visits a year, a blood test or two and various medications.

Deciding on whether to treat someone based on profit is not a good scenario. Fat cats in insurance companies and big pharma make way too much money and the administration costs are too high. Health quality in the US is about 30 on the list of civilized countries and we pay more for it than any other nation. Something is wrong with this system. Quality health care should be free and available to all US citizens. Scum bag insurance companies and big profits should be eliminated.

Insurance is a legalized scam. You just pay and pay and pay and most the time you get very little back. When you do need to make a claim they try and screw you out of what they promise. Insurance companies are the scum of the earth and I would be embarrassed to reach the Pearly Gates at the end of my life and have to admit that I spent my life taking money from people and giving them nothing in return but promises and lies. What a useless existence to society.

That's my Red Neck thoughts, feel free to pass it on,

So the government can't do anything right?

2009-08-28T11:36:00.000-07:00

The following was sent to me by my good friend Dennis:

An American Conservative Writes on Healthcare

This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the US department of energy.

I then took a shower in the clean water provided by the municipal water utility.

After that, I turned on the TV to one of the FCC regulated channels to see what the national weather service of the national oceanographic and atmospheric administration determined the weather was going to be like using satellites designed, built, and launched by the national aeronautics and space administration.

I watched this while eating my breakfast of US department of agriculture inspected food and taking the drugs which have been determined as safe by the food and drug administration.

At the appropriate time as regulated by the US congress and kept accurate by the national institute of standards and technology and the US naval observatory, I get into my national highway traffic safety administration approved automobile and set out to work on the roads built by the local, state, and federal departments of transportation, possibly stopping to purchase additional fuel of a quality level determined by the environmental protection agency, using legal tender issued by the federal reserve bank.

On the way out the door I deposit any mail I have to be sent out via the US postal service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the department of labor and the occupational safety and health administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to my house which has not burned down in my absence because of the state and local building codes and fire marshal's inspection, and which has not been plundered of all its valuables thanks to the local police department.

I then log on to the internet which was developed by the defense advanced research projects administration and post on freerepublic.com and fox news forums about how SOCIALISM in medicine is BAD because the government can't do anything right.

Oregon Doctors are MAD AS HELL

2009-08-27T23:19:00.000-07:00

HEALTH CARE FOR PEOPLE - NOT PROFIT!

Mad as Hell
http://www.madashelldoctors.com/

You CAN handle the Truth
There's no nice way to say it. The financial cost of health care is killing our citizens, hobbling our economy, crushing small business, and threatening the solvency of our government. In the meantime, the Health Care Industry is spending almost two million dollars a day lobbying Congress and manipulating public opinion to accept “reform” legislation that leaves a vicious, for-profit system intact. The "public option" is a trap. We need real reform that finds immediate savings, controls costs, and accomplishes the moral imperative of true Universal Access. A Single Payer plan is the only real path to a Health Care System that is socially, ethically and fiscally responsible. And yet, our elected officials refuse to even discuss the possibility of a Single Payer plan!
If that doesn't make you mad, we recommend checking your pulse.

The "public option" is doomed.
First: we will still have a dysfunctional health care system designed around insurance companies. Second: it will be impossible to cover everyone without raising taxes. The Obama administration is already saying it is acceptable to leave out 15 million people. Which 15 million? Will you be one of them? Who gets to decide? Third: in a "post-option" environment you can bet that the health insurance industry will manipulate the rules so that the sickest, most expensive patients will gravitate toward the public plan, which will cause it to fail. When it does, the opponents of real reform will point to the "public option" and scream: "See! Single Payer won't work!"

There is a time for compromise - this isn't one of them.
We are a small group of Oregon-Based doctors who care. We believe there is only one way to control costs, one way to remove profiteering from the system, one way to reclaim the care of our patients, and one way to be sure everyone is covered: we must replace our current pay-or-die system and with a comprehensive, publicly financed, privately delivered, Single Payer system that puts people first. Our moment to take a stand for Single Payer is NOW. We may not have another opportunity like this in our lifetime. Please support this unprecedented road trip to real health care reform.

http://www.madashelldoctors.com/

What our neighbors north of the boarder think of USA health care.

2009-08-26T15:08:00.000-07:00

Published on Wednesday, August 26, 2009 by The Ottawa Citizen (Canada)
A Bailout for the US Healthcare Industry
by Rose Ann DeMoro

The fractured U.S. healthcare debate, replete with wild distortions of Canada's medicare, must seem incomprehensible to many north of our border.

News images of fabricated "death panels" or traumatized seniors on U.S. Medicare -- a government-funded program -- urging legislators to keep the government's hands "off my Medicare" must seem especially hard to fathom.

Equally puzzling, no doubt, has been the reaction of the administration and many of its allies in Congress whose response to the attacks is to move further away from comprehensive reform.

Entering the year with a Democratic president and strong majorities in both houses of Congress, and a clear public mandate to end our long health-care nightmare, President Barack Obama and Congressional leaders decided to compromise from the outset, and not pursue the most effective reform, Medicare for all.

Gambling they could bring along conservative opponents, the administration and Congressional leaders instead advanced a more limited plan that preserves the role of the insurance industry. Prospects of broader reform were further undermined by some liberal and progressive groups and labour unions, who chose to merely endorse the proposals of the administration and top Congressional Democrats, rather than fighting for a national system like single-payer, which many of them have long endorsed.

Overnight, the left flank was effectively gutted from the beginning of the fight. Most of the pressure has thus come from the right and those who embrace the status quo -- leading to further compromises by both Obama and the leading Democrats.

This retreat was clearly articulated by the former president, Bill Clinton, who chastised a conference of worried netroots activists Aug. 13, saying "I want us to be mindful we may need to take less than a full loaf."

But mobilizing activists for a half loaf has proven to be a challenge, as the White House and Congress have learned to their dismay in recent weeks as they struggle to counter those denouncing them from the right.

Even the grassroots network built by candidate Obama that set new standards for campaign activism last year has, the New York Times noted Aug. 15, failed to produce much enthusiasm for the current health plan, and most liberal constituency groups have not fared much better.

What's left is a proposal that will force the uninsured to buy private insurance with subsidies for low-income earners and only limited constraints on industry price gouging and care denials that characterize the collapsing insurance-based system.

In sum, it looks like another massive corporate bailout, following the earlier version for the banks, this time for an equally unpopular insurance industry, which will fuel even more public cynicism of the reform process and political system.

To residents of all other industrialized countries, terrors over a government role in promoting and protecting the health and safety of its citizenry, and the reluctance of political leaders to effectively respond to these attacks must be especially confounding. Among major nations, only in the U.S. is health care not a fundamental right, but bartered for profit by a maze of health-care corporations. The result is that the U.S. continues to fall far behind other industrial nations in a variety of measurements, from access to care to equality in treatment, and even in the much discussed issue of waiting times for medical care.

While the U.S. spends twice as much as every other nation on per capita health care, there remain more than 45 million Americans with no health coverage and tens of millions more with insurance who are routinely denied medical care because their insurer doesn't want to pay for it.

Medical bills account for 62 per cent of personal bankruptcies. Half of all Americans skip doctor visits or immunizations for their children because of high out-of-pocket costs, troubling news indeed with the U.S. already leading the globe in swine flu infections and deaths.

The nation's registered nurses and many doctors continue to press for real change, a national or single-payer system that would look familiar to Canadians and the rest of the industrial world. It is still possible to achieve stronger reform, but time is running out.

© Copyright (c) The Ottawa Citizen
Rose Ann DeMoro is executive director of the 86,000-member California Nurses Association/National Nurses Organizing Committee, the largest U.S. union of nurses.

Complex and Complicated: America needs to be educated

2009-08-22T12:33:00.000-07:00

The health care debate has become extremely complex and complicated. So much so that there is more misinformation than credible information. The fact that our health care system is broken and needs reform is unquestionable. What to do and how to do it is very difficult. The politicalizaton of health care will result in the status quo. That is, lack of access to health care for tens of millions of Americans, and continued rising costs. This seems to be the true goal of special interest and the GOP. Without real reform, we are all in big time trouble. What makes this really strange is that opponents of health care reform will suffer as much as proponents of health care reform. Go figure!

That being said, the following issues must be addressed in order for real reform to take place.

1) Insurance industry must have to compete with Medicare for ALL (public option) in order to drive down costs.

2) Pharmaceutical and medical device companies must have to compete in order to drive costs down.

3) Tort reform must be included in order to increase access to health care and to drive costs down. Professional liability insurance is far too expensive for health care providers to make ends meet. Providers require more protection while patients require recourse to gross negligence. A middle ground must be created so that access to health care will be made available at a reasonable cost. Our finest legal minds should be working on a solution to this signifcant infulence in health care costs.

4) Providers must have to compete for patients in order to drive down costs.

5) Access to health care MUST NOT BE LIMITED. Pre existing conditions, delay in treatment, and denial of payment for health care must be removed from the equation.

6) We must change the way we think about health. We must develop knowledge and strategies that promote wellness beginning with prenatal care and in the schools. This includes how and what we eat, drink, and consume. This includes behavioral health and not just physical health.

7) When treating illness and injury, patients must have some responsibility unless they are totally disabled and have no resources (see number 9 below).

8) If a non US citizen is injured or becomes ill, they must pay for the health care or their country of origin should pay for the health care. An alternative could be international health insurance.

9) Medicare should be expanded to include any American who wants it. We all pay for Medicare through our employment. Those who are self employed pay for Medicare when they pay their taxes. Medicare requires some modification as well. For example, since there would be no more co-pays, insurance premiums, or deductibles in a public plan (Medicare for All), current Medicare payroll deductions could be increased 15%--20% to fund a public plan. Further, Medicare reimbursement to providers must be increased to reasonable levels. And finally, balances between fees for service and Medicare reimbursement must be negotiated to an agreeable level between patient and provider. This will place health care decisions where it belongs between patient and provider and bring free enterprise back to medicine.

10) By addressing issue number 9, there will be an increase in applications to medical school resulting in generating more primary care physicians and specialists. Currently we are on track for major shortage of health care providers in the not to distant future.

11) If the above issues are addressed, all current government programs would be consolidated into one single payor system. VA, Medicaid, Department of Labor, Worker's Compensation, etc would no longer be in the health care business resulting in significant cost containment.

12) There must be review and reform of regulations governing health care. Many of the existing regulations result in increased costs to providers which leads to increased costs for health care. This doesn't count the protections afforded to the insurance industry and pharmaceutical industry. Remove those loop holes and watch health care costs plummet

13) Ameliorate the waste in health care spending. This would save $1.2 trillion and could fund health care for all. The combination of health care insurance executive salaries, share holder profits, reduced waste, consolidation of existing government programs, and competition for policy holders, pharmaceuticals, medical devices, and patients would lead to REAL HEALTH CARE REFORM. That is, increased access to health care, significant cost containment, free enterprise back into medicine resulting in education and training of more providers.

14) REMOVE SPECIAL INTEREST FROM HEALTH CARE!!! Senators and Representatives must stop politicising health care and must stop taking campaign contributions from insurance companies, pharmaceutical companies, and professional organizations interested in maintaining the staus quo.

Something YOU can do

2009-08-20T10:05:00.000-07:00

I received an email from Stand Up for Health Care suggesting we all get involved in Health Care Reform. HEALTH CARE NOW is my attempt at getting involved. YOUR TURN

Death panels? Socialized medicine? What won't they say to stop reform?

Opponents of HEALTH CARE NOW are stopping at nothing to block health insurance reform, even if it means shouting outright lies in the media and in their communities. You can do something to help to take back the conversation and put an end to their disgraceful tactics.

Currently, your Senators and Representatives are in their home States. They are visiting local communities and holding town halls about health care reform. Attend a town hall near you and represent the truth. Find a local event near you at http://www.standupforhealthcare.org/

The majority of Americans recognize the urgent need for reform and support it. Don’t let shouting from angry mobs stop HEALTH CARE NOW.

Combat the false rhetoric, and give your representatives the best reasons for health insurance reform....your own personal stories. Communicate your issues about denial of coverage due to pre existing conditions, delay in treatment, denial of payment, extraordinary premiums that line the pockets of insurance company executives and shareholders. Talk about how WASTE exacerbates the high costs of health care. Talk about how life style impacts health (obesity, smoking, abuse of drugs and alcohol), and how we need primary prevention programs to promote health and avoid illness.

Talk about how we need to educate parents, teachers, and school boards about basic health, and more importantly, WELLNESS. The best cost containment method is to avoid illness. We all need to change the way we think about our health in order to change our behavior regarding our health. These are the issues that should be SHOUTED to our representatives. You know the truth, it is time you personally get involved.

With your help, we can fight back with the truth and obtain HEALTH CARE NOW for all Americans. Tell your neighbors and friends what the real facts are about health care reform.
Find an event and help spread the truth in your community.

Letter from Senator Barbara Boxer of California

2009-08-17T16:58:00.000-07:00

Following is a response from Senator Boxer to my letter discussing using the health insurance corporate profits, executive salaries, and savings from remedying and recovery of $1.2 trillion as a wasted expense in the current broken system to provide health care for ALL Americans. Unfortunately she does not address these issues. However, she does address issues of access to health care and cost containment. Please read on.

Dear Dr. Rubin:

Thank you for writing to me about pending health care reform legislation. I am committed to working with President Obama to ensure that Americans have access to high-quality, affordable healthcare that they can rely on. With the right legislation, I believe we can greatly improve care for our families, while containing the growing costs of health care.
The status quo is unsustainable- Americans will spend more than $2.5 trillion on health care this year, more than one in every six dollars in the U.S. economy. In all, we spend twice as much per person on health care than other advanced nations, yet the United States ranks near the bottom of the 30 leading industrialized nations in basic measures of health such as infant mortality and life expectancy.
The situation is even worse for individual families, who are struggling to afford skyrocketing premiums and increased co-pays and deductibles. Health care premiums have more than doubled in the last nine years, and one respected study shows that, if we fail to act, the average California family will have to spend 41 percent of its income for health insurance premiums by 2016.
The growing number of uninsured is also contributing to higher costs- 46 million Americans do not have health insurance, and every day, another 14,000 Americans lose their coverage when they become seriously ill or lose or change their jobs. To make up for the coverage gap, families pay on average an extra $1,100 a year in premium costs.
Moreover, poor regulation of insurance companies means that even those with health insurance coverage are not always guaranteed to get the benefits they are promised. Every day I hear from Californians who can't get health insurance because of a pre-existing condition, or who are denied the medical treatment prescribed by a doctor because of insurance company bureaucrats. This is wrong, and we have to do better for our families.
That is why I have joined President Obama and many of my colleagues in support of some basic principles for action. Any health care reform must allow every American who likes their current health coverage to keep it. Health coverage must be made accessible and affordable, and insurance companies must no longer be allowed to discriminate against those with pre-existing conditions or drop you if you become seriously ill. We must increase investments in prevention and wellness as that will save billions of dollars. And health care reform must not add a single dollar to the Federal deficit.
As we move to enact health care reform, I will fight for a bill that meets these principals. As a U.S. Senator, I can choose from a wide array of health care plans, and I believe that all Americans deserve this opportunity.
Again, thank you for writing to me. Please feel free to contact me again about this or other issues of concern to you.Barbara BoxerUnited States Senator

Obama Administration bows to special interest. GOP and Health Insurance Industry prevail

2009-08-16T22:42:00.000-07:00

WASHINGTON -Bowing to Republican pressure and an uneasy public, President Barack Obama's administration signaled Sunday it is ready to abandon the idea of giving Americans the option of government-run insurance as part of a new health care system.
Facing mounting opposition to the overhaul, administration officials left open the chance for a compromise with Republicans that would include health insurance cooperatives instead of a government-run plan. Such a concession probably would enrage Obama's liberal supporters but could deliver a much-needed victory on a top domestic priority opposed by GOP lawmakers.
Officials from both political parties reached across the aisle in an effort to find compromises on proposals they left behind when they returned to their districts for an August recess. Obama had wanted the government to run a health insurance organization to help cover the nation's almost 50 million uninsured, but didn't include it as one of his core principles of reform.
Health and Human Services Secretary Kathleen Sebelius said that government alternative to private health insurance is "not the essential element" of the administration's health care overhaul. The White House would be open to co-ops, she said, a sign that Democrats want a compromise so they can declare a victory.
Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.
With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.
"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."
Obama's spokesman refused to say a public option was a make-or-break choice.
"What I am saying is the bottom line for this for the president is, what we have to have is choice and competition in the insurance market," White House press secretary Robert Gibbs said Sunday.
A day before, Obama appeared to hedge his bets.
"All I'm saying is, though, that the public option, whether we have it or we don't have it, is not the entirety of health care reform," Obama said at a town hall meeting in Grand Junction, Colo. "This is just one sliver of it, one aspect of it."
It's hardly the same rhetoric Obama employed during a constant, personal campaign for legislation.
"I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices and assure quality is a public option that will force the insurance companies to compete and keep them honest," Obama said in July.
Lawmakers have discussed the co-op model for months although the Democratic leadership and the White House have said they prefer a government-run option.
Conrad, chairman of the Senate Budget Committee, called the argument for a government-run public plan little more than a "wasted effort." He added there are enough votes in the Senate for a cooperative plan.
"It's not government-run and government-controlled," he said. "It's membership-run and membership-controlled. But it does provide a nonprofit competitor for the for-profit insurance companies, and that's why it has appeal on both sides."
Sen. Richard Shelby, R-Ala., said Obama's team is making a political calculation and embracing the co-op alternative as "a step away from the government takeover of the health care system" that the GOP has pummeled.
"I don't know if it will do everything people want, but we ought to look at it. I think it's a far cry from the original proposals," he said.
Republicans say a public option would have unfair advantages that would drive private insurers out of business. Critics say co-ops would not be genuine public options for health insurance.
Rep. Eddie Bernice Johnson, D-Texas, said it would be difficult to pass any legislation through the Democratic-controlled Congress without the promised public plan.
"We'll have the same number of people uninsured," she said. "If the insurance companies wanted to insure these people now, they'd be insured."
Rep. Tom Price, R-Ga., said the Democrats' option would force individuals from their private plans to a government-run plan as some employers may choose not to provide health insurance.
"Tens of millions of individuals would be moved from their personal, private insurance to the government-run program. We simply don't think that's acceptable," he said.
A shift to a cooperative plan would certainly give some cover to fiscally conservative Blue Dog Democrats who are hardly cheering for the government-run plan.
"The reality is that it takes 60 percent to get this done in the Senate. It's probably going to have to be bipartisan in the Senate, which I think it should be," said Rep. Mike Ross, D-Ark., who added that the proposals still need changes before he can support them.
Obama, writing in Sunday's New York Times, said political maneuvers should be excluded from the debate.
"In the coming weeks, the cynics and the naysayers will continue to exploit fear and concerns for political gain," he wrote. "But for all the scare tactics out there, what's truly scary — truly risky — is the prospect of doing nothing."
Congress' proposals, however, seemed likely to strike end-of-life counseling sessions. Former Alaska Gov. Sarah Palin has called the session "death panels," a label that has drawn rebuke from her fellow Republicans as well as Democrats.
Sen. Orrin Hatch, R-Utah, declined to criticize Palin's comments and said Obama wants to create a government-run panel to advise what types of care would be available to citizens.
"In all honesty, I don't want a bunch of nameless, faceless bureaucrats setting health care for my aged citizens in Utah," Hatch said.
Sebelius said the end-of-life proposal was likely to be dropped from the final bill.
"We wanted to make sure doctors were reimbursed for that very important consultation if family members chose to make it, and instead it's been turned into this scare tactic and probably will be off the table," she said.
Sebelius spoke on CNN's "State of the Union" and ABC's "This Week." Gibbs appeared on CBS' "Face the Nation." Conrad and Shelby appeared on "Fox News Sunday." Johnson, Price and Ross spoke with "State of the Union." Hatch was interviewed on "This Week."
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
2009-08-17 01:34:37

$1.2 TRILLION wasteful spending in our health system

2009-08-14T19:15:00.000-07:00

Several months ago I wrote an article for a hospital trade publication about a hybrid Single Payor System. In it, I said that the amount of money generated to line the pockets of health insurance companies and pharmaceutical companies, plus the money SAVED from waste in health care spending could fund the entire single payor hybrid system that would provide quality health care for ALL AMERICANS. Below are the published findings by Pricewaterhouse Coopers at a Health Forum they hosted in Washington D.C. in April 2008. I think you will find this information staggering. We can all have health care just on the savings from waste alone.

The price of excess: Identifying waste in health care spending
Download http://www.pwc/en/healthcare/publications/the-price-of-excess.jhtml

To appropriately address waste in health spending, health industry leaders, policymakers and consumers must work together on system-wide goals and incentives. In April 2008, PricewaterhouseCoopers hosted the 180° Health Forum in Washington D.C., bringing together representatives of government, regulatory bodies and the nation’s largest hospitals and health systems, health insurers, pharmaceutical and life sciences companies to seek new, collaborative approaches to solving some of the health system’s most intractable problems.
These challenges — how to focus on prevention and wellness, how to drive greater quality and value into our healthcare system and how to ensure that our health system is resilient in the face of disaster — cut across traditional boundaries and requires that we think about our health system in new ways and consider innovative solutions.
As part of its preparation for the 180° Health Forum, PricewaterhouseCoopers’ Health Research Institute (HRI) interviewed more than 20 participants, reviewed more than 35 studies about waste and inefficiency in healthcare and surveyed 1,000 consumers to understand the public’s perception of waste and inefficiency in the system. From that research came The price of excess: Identifying waste in healthcare spending.
Key Findings
Our research found that wasteful spending in the health system has been calculated at up to $1.2 trillion of the $2.2 trillion spent in the United States, more than half of all health spending. Defensive medicine, such as redundant, inappropriate or unnecessary tests and procedures, was identified as the biggest area of excess, followed by inefficient healthcare administration and the cost of care necessitated by conditions such as obesity, which can be considered preventable by lifestyle changes. PricewaterhouseCoopers’ paper classified health system inefficiencies into three “wastebaskets” that are driving up costs:
Behavioral where individual behaviors are shown to lead to health problems, and have potential opportunities for earlier, non-medical interventions.
Clinical where medical care itself is considered inappropriate, entailing overuse, misuse or under-use of particular interventions, missed opportunities for earlier interventions, and overt errors leading to quality problems for the patient, plus cost and rework.
Operational where administrative or other business processes appear to add costs without creating value.
When added together, the opportunities for eliminating wasteful spending add up to as much as $1.2 trillion. The impact of issues such as non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity are exponential, and fall into all three baskets.
//

Email from Congressman Waxman of California

2009-08-14T01:02:00.000-07:00

Dear Dr. Rubin:

Thank you for contacting me to share your thoughts about comprehensive health care reform legislation. As a coauthor of H.R. 3200, the America's Affordable Health Choice Act, I appreciate having the benefit of your perspective and the opportunity to share my view.

I am a longtime supporter of efforts to provide comprehensive health care coverage for all, control medical and insurance costs, and enhance the quality and efficiency of the health care system. According to Families USA, nearly 87 million people-more than one-third of Americans under 65-went without health insurance at some point during the last two years. Uninsured patients go without the care they need and face the constant risk of ruinous debt if they contract a serious disease or have an accident. Those who have health insurance are finding their insurance plans are costing more and covering less. Furthermore, the cost of health care accounts for an increasingly large share of the economy and of government spending, and poses a fundamental threat to our economic stability and future prosperity.

H.R. 3200 is designed to reduce health care costs, protect and increase consumer choice, and guarantee access to quality, affordable health care for all Americans. The House Energy and Commerce Committee reported the legislation on July 31 and the full House is expected to take up the measure this fall. I hope you will visit http://energycommerce.house.gov/index.php for details about the bill, and you can count on me to keep your concerns in mind as the legislative process moves forward.

Thank you again for writing and please keep in touch on matters of concern.

With kind regards, I am

Sincerely,

HENRY A. WAXMAN
Member of Congress

2009-08-13T08:47:00.000-07:00

8 Reasons We Need Health Insurance Reform Now
1) Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html

2)Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html

3) Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html

4)Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes

5) Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline

6)The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction

7)Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html

8)The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

Don't take my word for it

2009-08-12T14:59:00.000-07:00

Tired of hearing me focus on the health care industry? Check this out!

http://www.youtube.com/watch?v=fBi2hMK1G8Y

http://www.youtube.com/watch?v=ICDKY5CwexA

http://sickforprofit.com/

2009-08-11T10:39:00.000-07:00

My most recent post on this blog has been censored by Facebook. The post was my reaction to an interview this morning on CNBC. I received the following message when clicking the "share" link on Facebook. "Some content in this message has been reported as abusive by Facebook users."

I guess the first amendment doesn't apply to Facebook

2009-08-11T08:22:00.000-07:00

Listening to Larry Kudlow interview a spokeswoman for the health insurance industry on CNBC this morning. She was defending the health insurance industry anti public health care plan position. Her main premise was that health care providers and hospitals would go BK if a public health care plan was created. When asked why, she danced around the question and finally stated that a public plan would not reimburse providers and hospitals enough to stay in business.

There is an interesting implication to her response. That is, insurance reimbursement is enough to keep providers and hospitals in business. This could not be further from the truth. In Southern California we have experienced a number of acute care and community hospitals closing its doors. We have experienced doctors and other providers leaving the state because they couldn't make ends meet. This is with health care insurance reimbursement, not a public health care plan.

Fact is the health insurance industry must protect their profits in order to satisfy shareholders and pay the salaries noted in previous posts. If the health insurance industry had to compete with a public plan, they would experience a tremendous drop in revenue in order to compete. In other words, perhaps her comments are a self fulfilling prophecy. If health insurance companies had to compete with a public plan, maybe they would go BK.

Providers and hospitals are NOT afraid of a public plan as this woman alleged. Providers spend an extraordinary amount of money working through the existing system controlled by the health insurance industry. We must have resources dedicated to verifying benefits, certifying procedures, appealing denials, and fighting for reimbursement. This craziness MUST STOP. The resources used to fight with insurance companies should be redirected to providing health care.

The health insurance industry would have you believe that a public plan is socialism, that a public plan will cause providers and hospitals to go bankrupt, and that a public plan will create death squads for the elderly. These scare tactics are designed to defeat "Medicare for ALL." Truth is, these scare tactics are designed to protect insurance company corporate profits and executive salaries. Don't be fooled by this greed driven industry. A public plan that allows patients and providers to make health care decisions and negotiate balances is the hybrid system that will result in immediate reduction in health care costs and BETTER HEALTH CARE.

Letter to President Obama re: Health Care Reform

2009-08-09T12:22:00.000-07:00

July 27, 2009

President Barack Obama
The White House
Washington, DC

Dear Mr. President:

It is with great admiration and respect that I write you this letter regarding the state of health care and access to health care in our country. As you are well aware, this issue is of utmost importance and very complex. I am extremely supportive of health care reform and access to health care for those who can and those who cannot afford it..

I have been a health care provider since I completed my training at Cook County Hospital in 1972. I am currently the CEO of Museum Center Surgery Group, Inc., and the Chief Administrator of National Stand Up Imaging, LLC in Los Angeles. I am a certified medical psychologist and a Fellow and Diplomate of the American Academy of Pain Management. As a medical and behavioral health care provider and health care administrator for over 35 years, I believe I have the knowledge base and a somewhat unique perspective on health care delivery.

My primary concern relates to the state of the health insurance industry, the pharmaceutical industry, and the actual delivery of health care. Health insurance companies do NOT provide health care. They are in business to make money. In fact, they refer to claims as medical losses. They have an inherent conflict of interest in that they currently determine what can or cannot be provided to their policy holders. This is done even though there are laws that prohibit the corporate practice of medicine.

The obvious conflict is the entity that is to pay for the health care determines what health care is to be provided. This context has an immediate and negative impact on the decision making and relationship between the provider and patient, while ensuring the profitability and viability of the insurance company. This conflict places all health insurance policy holder’s health and possibly their lives at risk.

During your campaign, you mentioned your own personal family experience fighting with your health insurance company. You are a highly educated person with skills of persuasion that most Americans do not have. If you and your mother had difficulty with your insurance company, what possible chance does the average American have fighting their insurance company for necessary treatment?

The financial motives and greed on the part of the health insurance industry and the pharmaceutical industry are expensive and places lives at risk. There cannot be real and significant health care reform without insurance reform. In fact, if the health insurance company was removed from the equation, the amount of money generated from industry operating expenses, obscene salaries to executives, and corporate profits would go a long way in paying for a hybrid single payor system.

I understand that removing the “middle man” from the health care equation is a very difficult proposition. The insurance companies pour millions and possibly billions of dollars into the campaigns of their selected legislators in state and federal government. Motivating legislators to pass a reform bill that is opposed by their campaign contributors is highly unlikely. However, if you add the campaign contributions to the obscene profits generated by the insurance industry and pharmaceutical industry, we could go even further in covering the expense of a hybrid single payor system where health care decisions are made between provider and patient. As I mentioned earlier, there can be no real health care reform without insurance reform. It is time to remove special interest from the health of our citizens.

I have been an advocate of a hybrid single payor system for years. We all ready have Medicare in place, and an expansion of the Medicare system would suffice to provide basic health care for all.

There needs to be some changes in the current Medicare system to make this work for patients and providers. Currently, CMS determines the value of the health care service and the provider must accept that value unconditionally. Medicare then pays 80% of the reimbursement and the patient is responsible for 20%, independent of the patient’s economic status and the provider’s fees. If the rules were changed to allow the provider and patient to negotiate balances, the health care decision making would be where it belongs; provider and patient. That decision includes who the patient chooses as their providers. Currently that choice is only available with PPO plans. HMO, IPA, and other managed care programs limit the patient’s access to providers participating in those plans. These entities take from the system. They add nothing nor do they actually provide care. Many patients choose to go out of network and are financially “punished” by the insurance company. This would all end if health care reform resulted in a hybrid single payor system. The model for this system is New Zealand where they have basic single payor coverage and the balances are dealt with separately.

Another change in Medicare that would better the system is how individuals contribute to the funding of the system. Currently, employees have money deducted from their paychecks that is contributed to Medicare. All working Americans understand that they are contributing in the present to pay for health care in the future. We all must realize that health care reform will change the way we think about health care. For example, since their will be no premium payments for basic health care under the reformed system, an increase in the deduction for government sponsored health care would be necessary. Since this increased deduction (I believe we could manage with a 15% increase over current Medicare deduction) will be far less than the insurance premiums paid for by individuals and employers, Americans would experience the satisfaction of access to health care of their choice and determining what the expense of their health care will be (in advance).

It is also important to consider the provision of and costs of catastrophic disease, hospitalization, rehabilitation services and end of life health care. These issues are complex and can be very expensive. The hybrid single payor system encourages negotiating the difference between the providers fees and the CMS reimbursement. This would result in an immediate incentive for providers to compete for patients. That includes hospitals, hospices, step down facilities, nursing homes, assisted living facilities, surgery centers, diagnostic imaging centers, behavioral health care facilities, rehabilitation facilities, in addition to individual providers. This competition will have an immediate effect of lower health care costs. Further, if the pharmaceutical and medical device industries had to compete in an “open market,” the cost of pharmaceuticals and medical devices would plummet. Of course, there is the same “special interest” problem with the pharmaceutical companies as there is with the health insurance industry that must be addressed by you and our legislators.

Mr. President, I am proud of the way you have taken on this issue. I am proud of you for your stance against undue influence by special interest in your administration. I am proud to say I voted for you and I wish you and your family wellness. Health care reform is a necessity. Instituting a hybrid single payor system would put free enterprise back into health care, and would provide every American with access to the health care they require. Thank you for listening.

My best regards,

Howard Stanley Rubin, MP, PhD
Los Angeles, California
www.mmosc.com

2009-08-08T05:41:00.000-07:00

Welcome to Health Care Now. This Blog is dedicated to fixing a very broken health care system in the USA.

There can be no real health care reform without insurance and pharmaceutical industry reform. Health Insurance and Pharmaceutical Companies DO NOT PROVIDE HEALTH CARE. These companies are in busines to make money for their shaeholders and executives. Check this out!

UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)

CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year.

Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)

Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (source)

Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500

WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700

This is just a handful of health insurance executives. None of these people have ever diagnosed or treated any patient in their executive capacity. In fact, they participate in developing company policy that limits health care to their policy holders and in many cases deny health care to their policy holders. Withholding funding for health care is how these obscene salaries are paid.

Remove health insurance companies from the equation and all this money could actually be used to provide health care for those in need.