Sunday, January 31, 2010

What others believe - Lance Armstrong Foundation

While LIVESTRONG has not endorsed any specific reform plan, we stand firmly in favor of comprehensive reform that embraces the following fundamental principles:

  • Guaranteed Security and Continuity: All Americans must be able to rely on the continuation of their coverage, regardless of changes in health, family or profession.
  • Delivery of Proven Care: Services known to prevent cancer and other diseases and preserve general health must be part of standard coverage.
  • Equality: Americans must not be denied coverage for pre-existing health conditions and should have choices appropriate to their own health needs.
  • Medical Excellence: Reform must include a continuing effort to promote best medical practices, put the patient first and deliver modern, innovative care.

LIVESTRONG will continue to serve as an honest broker during the health care reform conversation to ensure that these principles are included in a final health reform measure.

A call to action for your brothers and sisters in Christ

“Those who don't know history are destined to repeat it.” - Edmund Burke

First they came for the communists, and I did not speak out—because I was not a communist;
Then they came for the trade unionists, and I did not speak out—because I was not a trade unionist;
Then they came for the Jews, and I did not speak out—because I was not a Jew;
Then they came for me—and there was no one left to speak out.
                                                                        - Martin Niemöller, German pastor and theologian

Now is your time to speak out for people who die for lack of health care or are financially ruined by a catastrophic accident or illness.  Learn about and support Medicare for all.  We can afford it, the medical industry and the conservatives just don't want you to believe it.  What we can't afford is to do nothing or what Congress would foist upon us to benefit their corporate sponsors.

What Would Jesus Do?
Heal the sick, support the weak, comfort the afflicted.


Here's a segment I caught on my way home from church this morning. It is food for thought on reform. It doesn't take sides, I hope you will listen.

Wednesday, January 27, 2010

Even ‘responsible’ people devastated by lack of insurance

5:52 PM Friday, December 18, 2009 - Dayton Daily News

To those letter writers, conservative pundits and talk radio “entertainers” who imply that the lack of health insurance is a question of personal responsibility and the government should not interfere, I have a few questions:
• If a person is denied health insurance because of a pre-existing condition, is that due to the person’s lack of responsibility or an irresponsible insurance industry?
• If a person purchases insurance, but then is denied coverage when he or she experience a serious injury or illness, is this irresponsible behavior on the part of the patient or the insurance company?
• If a person loses a job due to downsizing, and, as a result, loses health insurance, is this due to a lack of personal responsibility?
• If a person is driven into bankruptcy or the loss of his or her home due to unforeseen medical expenses or medical expenses insurance won’t cover, is this due to lack of personal responsibility?
It is insulting to imply that people who have been so devastated by the U.S. health care system could have avoided their predicament if they had just been more responsible. It takes a complete lack of compassion not to realize that many of us are just lucky we aren’t in their shoes. 
Daniel E. Fraga
New Carlisle

Sunday, January 17, 2010

Testimony of Wendell Potter, Philadelphia, PA Before the U.S. Senate Committee on Commerce, Science and Transportation

June 24, 2009
Mr. Chairman, thank you for the opportunity to be here this afternoon.
My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick – all so they can satisfy their Wall Street investors.
I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand—or even to obtain—information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.
When I left my job as head of corporate communications for one of the country’s largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry’s charm offensive—which is the most visible part of duplicitous and well-financed PR and lobbying campaigns—may well shape reform in a way that benefits Wall Street far more than average Americans.
A few months after I joined the health insurer CIGNA Corp. in 1993, just as the last national health care reform debate was underway, the president of CIGNA’s health care division was one of three industry executives who came here to assure members of Congress that they
would help lawmakers pass meaningful reform. While they expressed concerns about some of President Clinton’s proposals, they said they enthusiastically supported several specific goals.
Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn’t be here today.
Today we are hearing industry executives saying the same things and making the same assurances. This time, though, the industry is bigger, richer and stronger, and it has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers.
The average family doesn’t understand how Wall Street’s dictates determine whether they will be offered coverage, whether they can keep it, and how much they’ll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies’ quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical ―benefit‖ ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.
To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going
to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they’ve failed to trim medical costs. I have seen an insurer’s stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company’s first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later.
To help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation’s largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.1 The Energy and Commerce Committee’s investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.
They also dump small businesses whose employees’ medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether –
1 Samuel Zuvekas and Joel Cohen, “Prescription Drugs And The Changing Concentration Of Health Care Expenditures,” Health Affairs, 26 (1) (January/February 2007): 249-257.
leaving workers uninsured. The practice is known in the industry as ―purging.‖ The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation.
An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust’s members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere.
Purging through pricing games is not limited to letting go of an isolated number of unprofitable accounts. It is endemic in the industry. For instance, between 1996 and 1999, Aetna initiated a series of company acquisitions and became the nation’s largest health insurer with 21 million members. The company spent more than $20 million that it received in fees and premiums from customers to revamp its computer systems, enabling the company to ―identify and dump unprofitable corporate accounts,‖ as The Wall Street Journal reported in 2004.2 Armed with a stockpile of new information on policyholders, new management and a shift in
2 “Behind Aetna’s Turnaround: Small Steps to Pare Cost of Care,” Wall Street Journal, August 13, 2004.
strategy, in 2000, Aetna sharply raised premiums on less profitable accounts. Within a few years, Aetna lost 8 million covered lives due to strategic and other factors.
While strategically initiating these cost hikes, insurers have professed to be the victims of rising health costs while taking no responsibility for their share of America’s health care affordability crisis. Yet, all the while, health-plan operating margins have increased as sick people are forced to scramble for insurance.
Unless required by state law, insurers often refuse to tell customers how much of their premiums are actually being paid out in claims. A Houston employer could not get that information until the Texas legislature passed a law a few years ago requiring insurers to disclose it. That Houston employer discovered that its insurer was demanding a 22 percent rate increase in 2006 even though it had paid out only 9 percent of the employer’s premium dollars for care the year before.
It’s little wonder that insurers try to hide information like that from its customers. Many people fall victim to these industry tactics, but the Houston employer might have known better – it was the Harris County Medical Society, the county doctors’ association.
A study conducted last year by PricewaterhouseCoopers revealed just how successful the insurers’ expense management and purging actions have been over the last decade in meeting Wall Street’s expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients.
There are many ways insurers keep their customers in the dark and purposely mislead them – especially now that insurers have started to aggressively market health plans that charge relatively low premiums for a new brand of policies that often offer only the illusion of comprehensive coverage.
An estimated 25 million Americans are now underinsured for two principle reasons. First, the high deductible plans many of them have been forced to accept – like I was forced to accept at CIGNA – require them to pay more out of their own pockets for medical care, whether they can afford it or not. The trend toward these high-deductible plans alarms many health care experts and state insurance commissioners. As California Lieutenant Governor John Garamendi told the Associated Press in 2005 when he was serving as the state’s insurance commissioner, the movement toward consumer-driven coverage will eventually result in a ―death spiral‖ for managed care plans. This will happen, he said, as consumer-driven plans ―cherry-pick‖ the youngest, healthiest and richest customers while forcing managed care plans to charge more to cover the sickest patients. The result, he predicted, will be more uninsured people.
In selling consumer-driven plans, insurers often try to persuade employers to go ―full replacement,‖ which means forcing all of their employees out of their current plans and into a consumer-driven plan. At least two of the biggest insurers have done just that, to the dismay of many employees who would have preferred to stay in their HMOs and PPOs. Those options were abruptly taken away from them.
Secondly, the number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance. The industry is insistent on being able to retain so-called ―benefit design flexibility‖ so they can continue to
market these kinds of often worthless policies. The big insurers have spent millions acquiring companies that specialize in what they call ―limited-benefit‖ plans. An example of such a plan is marketed by one of the big insurers under the name of Starbridge Select. Not only are the benefits extremely limited but the underwriting criteria established by the insurer essentially guarantee big profits. Pre-existing conditions are not covered during the first six months, and the employer must have an annual employee turnover rate of 70 percent or more, so most of the workers don’t even stay on the payroll long enough to use their benefits. The average age of employees must not be higher than 40, and no more than 65 percent of the workforce can be female. Employers don’t pay any of the premiums—the employees pay for everything. As Consumer Reports noted in May, many people who buy limited-benefit policies, which often provide little or no hospitalization, are misled by marketing materials and think they are buying more comprehensive care. In many cases it is not until they actually try to use the policies that they find out they will get little help from the insurer in paying the bills.
The lack of candor and transparency is not limited to sales and marketing. Notices that insurers are required to send to policyholders—those explanation-of-benefit documents that are supposed to explain how the insurance company calculated its payments to providers and how much is left for the policyholder to pay—are notoriously incomprehensible. Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that’s exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.
Thank you, Mr. Chairman, for beginning this conversation on transparency and for making this such a priority. S. 1050, your legislation to require insurance companies to be more honest and transparent in how they communicate with consumers, is essential. So, too, is S.
1278, the Consumers Choice Health Plan, which would create a strong public health insurance option as a benchmark in transparency and quality. Americans need and overwhelmingly support the option of obtaining coverage from a public plan. The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent, publicly-accountable health care option as a ―government-run system.‖ But what we have today, Mr. Chairman, is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.

Tuesday, January 12, 2010

Response to letter to editor on "failing government"

To President Obama and all 535 voting members of the Legislature.   It is now official, you are ALL corrupt morons:

Power corrupts and absolute power corrupts absolutely.   People in politics want to be re-elected and therefore gladly accept contributions to their re-election war chests.   The way around this is not to allow political contributions but to make all candidates accept a “fair share” of election money and nothing more.   That should level the playing field.

Obama should have accepted his fair share in his run for President but he didn’t; instead he chose to stick it in the craw of the Powerful Elite - - i.e. the monied interests - - by playing their game.   He was successful because so many little people desperately wanted change.   So far, he has disappointed many little people.

The acceptance of money for re-election war chests does make it appear that our elected officials have been “bought”.   Congressmen and Senators should be made to wear jackets like NASCAR drivers with their big contributors’ logos on them for all to see.   That way the electorate back home could decide if indeed their congressional delegation had been bought and vote them out of office.

The U.S. Post Service was established in 1775. You have had 234 years to get it right and it is broke.

Beyond me why everybody singles out the Post Office and says “UPS makes a profit; why can’t the US Postal Service?’  Two things you should understand:  The USPS serves every nook and cranny of every “Sleepy Hollow” in the country - - while UPS serves only those places where it can make a profit.   Also, the USPS is nothing but a subsidy to American business for distribution of bills, catalogs and sales literature - - to help American businesses stay in business.   Ever hear of “Bulk Rates?”   Who do you think “Bulk Rates” are for?   Certainly not for you and me.   Shouldn’t first class postage apply to catalogs, sales literature – and for that matter, magazines like Time and US News and World Report?   Remember that if it did, their cost of doing business would be more and the prices you and I pay would be higher.

I for one think the USPO does a pretty good job, given the above constraints.

Social Security was established in 1935. You have had 74 years to get it right and it is broke.

Social Security is a great program.   It was established specifically to take care of the elderly and the disabled.   Before Social Security, the elderly were the responsibility of their children or their churches.   That was well and fine while the nation was agrarian.   All an adult child had to do was plant a few more acres and have a few more chickens to take care of his parents.

A funny thing happened around 1890.   The country started shifting from agrarian to industrial.   So what should we have done with the aging parents?   Perhaps we should have lined them up against the wall and shot them.   After all, their children were having a tough enough time taking care of themselves.

Why not let the churches take care of them?   The funny thing is that churches are local.   As a rule, poor churches serve poor sections of town and rich churches serve the more affluent sections of town.   Do you really think that parishioners in the Country Club district would bother with providing for the elderly in the poorer sections of town?   Dream on.

Fannie Mae was established in 1938. You have had 71 years to get it right and it is broke.

Fannie Mae and Freddie Mac are not part of the US Government per se.   Instead, they are what are called government-sponsored enterprises (GSE’s).   GSE’s are a group of financial services created by the US Congress to enhance the flow of credit to targeted economic sectors.

Congress created GSE’s to enhance the availability and reduce the cost of credit to agriculture, home financing and education.   This makes those targeted economic sectors more efficient and transparent.

During the Great Depression, borrowers defaulted on mortgages right and left with the result that banks found themselves strapped for cash.   FDR and Congress created Fannie Mae to buy mortgages from lenders, freeing capital that could go to other borrowers.

Fannie Mae helped usher in a new generation of American home ownership, paving the way for banks to loan money to low- and middle-income buyers who otherwise might not have been considered creditworthy.

During budget difficulties at the time of the Viet Nam war, LBJ requested that Congress take Fannie off the government balance sheet and convert it into a publicly traded company owned by investors.   Two years later, Freddie Mac was launched, primarily to keep Fannie Mae from functioning as a monopoly.

Today, Fannie and Freddie dominate the mortgage markets.   Fannie and Freddie raise cash to buy mortgages from a variety of sources, including pension funds, mutual funds and foreign governments.   Their influence is large enough that the Federal Reserve and the Treasury felt the need to assure that Fannie and Freddie would not be permitted to collapse from reverberations of the sub-prime mortgage debacle under Bush II.

Historically, right wingers have been Fannie’s and Freddie's most vocal critics, arguing that Fannie’s and Freddie’s ties to the U.S. Government give them an unfair advantage over others in the industry.   Whether it does or does not, I can not say for sure.   But I do know that many people would not be home owners if it weren’t for Fannie and Freddie.

War on Poverty started in 1964. You have had 45 years to get it right; $1 trillion of our money is confiscated each year and transferred to "the poor" and they only want more.

You don’t want to get me started on this one.   I am getting smarter in this area because of what I am doing to help get campus facilities for the intellectually and developmentally disabled into the Dayton area.

What LBJ did for the really little guy in terms of the “Great Society” was great.   Unfortunately, Ronald Reagan and Dean Stockwell did a hatchet job on the “War on Poverty” and the country still has not recovered.

When Ronnie did his hatchet job, it fell upon the “nonprofit” sector to pick up the slack.   Today, the nonprofit sector stands at a crossroads.   Government budget cuts starting with Reagan have eliminated a significant source of nonprofit revenues and have created a serious fiscal squeeze for many organizations that traditionally help the poor and the disabled.

Although the non profit sector as a whole managed to replace its lost revenue, it did so through increasing fees and charges.   That attracted for-profit businesses into traditional nonprofit fields.   That in turn created a serious economic challenge to the non profit sector.

Questions have been raised about what some see as over professionalization and bureaucratization among the nonprofits.   This has undermined public confidence and prompted questions about the basic legitimacy of the special tax and legal benefits nonprofits enjoy while providing service to the poor and the disabled.

Thank you Ronnie.   You did great.

Medicare and Medicaid were established in 1965.   You have had 44 years to get it right and they are broke.

See the rationale I provided for Social Security.   It also applies here.

Medicare and Medicaid are great programs for the elderly and the disabled.   FDR and HST tried to get Medicare passed but were unable.   LBJ did by twisting arms of Senators and Congressmen who “owed” him.

Thank heaven that he did.   That kept so many decent Americans from having to bankrupt their selves to provide medical care for their parents or their disabled children.

I still remember the TV news the day that LBJ flew to Independence MO to sign the legislation at Harry Truman’s home and to give Truman the first Medicare card.   How happy HST was.   It was a great day for America.

Medicare is so great; I fervently hope that we can get “Medicare for all”.   The country needs it desperately.

The Department of Energy was created in 1977 to lessen our dependence on foreign oil.   It has ballooned to 16,000 employees with a budget of $24 billion a year and we import more oil than ever before.   You had 32 years to get it right and it is an abysmal failure.

I do not know as much about the Department of Energy as I do about other things so I am asking you to extrapolate from the generalities about the need for government that I provide in the next section.   I will say this though: America’s dependence on foreign oil must be reduced.

You have FAILED in every "government service" you have shoved down our throats while overspending our tax dollars.

Government has to be ready to do what private enterprise will not.   At the local level, police, fire, schools, utilities – and especially, the courts are examples of government services.   So is snow removal which is so important from a safety standpoint in a nation which has so many automobiles on the road.

At the national level, Military power is the most important.   Taxation and appropriation follow closely.   And of course, the national court system where the Judiciary is one of the three branches of government.   Ever wonder why?

America is a country of the rule of law.   What good would a contract be if there were no courts to enforce it?   Without laws and the courts to enforce them, there would be absolute chaos.   Is that what you who are so anti government want?   There must be government for the nation to survive.

What do you think the odds would be that private enterprise would build something like the Tennessee Valley Authority dams which were built to jump start economic activity in the South?   Or for that matter, how about all the hydroelectric dams in the Southwestern U.S. which are the main source of fresh water for desert areas.   How many people do you think would live in the Greater LA metropolitan area, Phoenix, Tucson, El Paso Las Vegas or Albuquerque without water from these dams?   Where do you think a good chunk of the electricity for the people that live there come from?


You asked for it.   This is an area I know a little about.

If you want to read “My Daughter’s medical Horror Story” which I was able to get to various Senators and Representatives in Washington, just let me know and I will send it to you electronically.

Caring for the sick is first and foremost, a moral issue.   Supposedly, America is a Christian country.   Ask yourself, “What would Jesus do?”   Would He not heal the sick, support the weak, and comfort the afflicted.   That is exactly what a universal health care system seeks to do.   A “Single Payer” system would be the best choice among universal health care possibilities.

Here are some health care reform myths.   If you believe these myths, then the Medical – Industrial Complex “lobbying” of Congress has done a job on you.

Universal coverage costs too much:   No it doesn’t.    Every other industrialized nation offers universal coverage at a cost much lower than the aggregate we spend in the US, a goodly portion of which goes to insurance and pharmaceutical profits.

Our taxes will go up:   Perhaps, but we are still going to come out ahead when aggregate expenses are considered.   Single Payer “taxes” will cost us less than the premiums, co-pays and medical bill we pay today.   Further, our health coverage will be secure regardless of income or status of employment.

Americans get world class care and we shouldn’t mess with that: in fact, many Americans do not get world class care.   Sure, world class care is available to those that are rich or have good insurance.    However, on almost all measures of health care and mortality, the United States still lags Canada and Europe.   Why is that if we have world class healthcare.

Other countries have much longer waiting times than we do: Actually there are no waiting lists for emergency surgery or urgently needed procedures in universal care countries.   Check for studies on wait times.

There is no health care problem; people can get care even if they are uninsured: Yes.   By law, a person cannot he turned down if he presents himself to an Emergency Room.   However, ERs are an expensive place to get treatment.   Further, even with the availability of expensive ERs, more than 60 Americans die daily from lack of care.   See for more.

And the biggie: “Single Payer” is socialized medicine.   No, single payer is not socialized medicine because government will not own the hospitals and physicians will not be on a government salary.   Single payer will work like today’s Medicare program for the elderly and the disabled where patients see private doctors and use private hospitals.   Clearly, “Single Payer” is not socialized medicine.   Single payer is actually public insurance rather than private insurance.   That is a great big difference.

So you need a job?   This is another biggie the Medical - Industrial Complex doesn’t want the American people to know:

When I was in college, Charlie Wilson said, “What is good for General Motors is good for the country.”   WRONG!!!   GM is now bankrupt.   One of the primary reasons they are is that GM has to buy medical insurance for its employees while their Japanese, German, British and Scandinavian competitors do not.   That is analogous to having the American runner carry a hundred pound weight in a foot race.

A national single-payer system would relieve corporations like GM of the burden of buying and administering health insurance, stabilize costs, and give them the global level playing field they need to compete in world markets.

American business can play a major role in solving the healthcare dilemma by overcoming their blind resistance to a universal care system and insisting instead that a national plan be designed to provide their employees with proper medical coverage without runaway costs.   Universal coverage such as a “Single-Payer” system offers the best hope of achieving these goals.

I would like to ask why the country considers humongous profits for the insurance industry more important than the other economic sectors being on a level playing field with their foreign competitors.

One final thing:   I am on the mailing list for Steny Hoyer’s “Daily Dose”.   From the Daily Dose sent at 5:26 PM Friday, January 8, 2010, I quote:  At the Time This Daily Dose Was Sent, Insured Americans Had Paid a “Hidden Tax” of $44,179,853,891 since January 1, 2009 in Additional Premium Costs to Cover Care for the Uninsured.

Folks, keep this circulating.   It is very well stated.   Maybe it will end up in the e-mails of some of our "duly elected' and their staff (they never read anything) will clue them in on how American's feel.

I will forward this to Congressional and Senate Staffers who have helped me get my daughter’s Medical Horror Story to the proper authorities.

Al Baca
(937) 236-0782

Sunday, January 3, 2010

It’s time for business community to take stand on health reform

It’s time for business community to take stand on health reform

By Hirsh Cohen
Business Courier of Cincinnati
Friday, December 4, 2009

The latest numbers are staggering. A new Harvard study in the American Journal of Public Health reports that nearly 45,000 deaths occur each year in the U.S. because of the lack of health insurance. That’s a death every 12 minutes.
Half of middle-class workers say they or a family member postponed, cut back or skipped needed care because of its cost, according to a June 2009 survey.
In my many years in public health, I am personally aware of dozens of people whose health suffered because they lacked insurance coverage. They put off care until their condition was critical, sometimes with catastrophic results.
Beyond the human toll, our fragmented and dysfunctional health system hurts us financially. Health care costs and insurance premiums are skyrocketing, unsustainably straining businesses and workers.
Sixty-two percent of personal bankruptcies are now linked to medical bills and illness, and more than three-quarters of those bankrupted had insurance when they got sick. Premiums for employer-sponsored coverage have more than doubled over the past decade.
Something’s terribly wrong
Regrettably, the bills emerging in Congress would do little to reverse these trends. They simply don’t go far enough.
The business community should be alarmed that we are getting so little return for our health care dollar. Our insurance premiums go up, but coverage deteriorates. We face more co-pays and deductibles, claim denials and hassles. In addition, the costs of providing care to the uninsured and underinsured are borne by a smaller pool of insured workers. It is estimated that almost 25 percent of our premiums fund Medicare, Medicaid and uninsured shortfalls.
The U.S. spends twice as much per capita on health care as any other Western nation but has much less to show for it in medical outcomes. We are No. 1 in dollars spent but 37th in performance out of the 191 countries tracked by the World Health Organization, placing us below Colombia, Saudi Arabia and Portugal.
Why? A big part of the answer is that we rely on a private insurance model. For all its net value, the system saddles us with enormous bureaucracy. (Approximately 31 percent of every dollar is spent on administration and profits instead of going toward care.)
In addition, we are focused on a medical services model and not a health care model; incentives exist to treat on a fee-for-service basis with little or no incentives for prevention and primary care.
The proposed legislative initiatives will help improve some access and possibly some costs, but the execution will be difficult and time-consuming. An expanded and improved version of Medicare would be more cost-effective and equitable. Some lawmakers say such an approach is unrealistic, but 44 years ago the same was said about Medicare.
My years of work in Canada convinced me that a single-payer model is workable and effective. It’s true that system is stressed and needs significant improvement, but the funding is more logical and no one in Canada declares bankruptcy because of medical costs. An American single-payer system would have its own features and enjoy better funding.
It is time that the business community take a strong stand to ensure that our nation joins the rest of the industrialized world and guarantee seamless health care coverage to every man, woman and child in America. That means a publicly financed, but privately delivered program of single-payer Medicare for All.
Let’s get serious, Cincinnati business community.
A Better Way
The benefits to businesses and the work force under a single-payer program:
• Both employees and employers would get more health care and less bureaucracy for every dollar spent.
• Medical bankruptcies would become a thing of the past.
• Employers would have a stronger incentive to move part-time workers to full time.
• With increased access to preventive care and wellness programs, employees would be healthier and miss less time from work.
• Employers would see a drop in liability insurance and workers’ compensation costs, an end to contentious negotiations with insurers, a reduction in retiree benefit costs and an end to complaints by employees over rising premiums and expenses.
• Finally, an improved Medicare for All would allow costs to be controlled and predictable, eliminating a major source of business uncertainty and a barrier to planning.
Cohen holds a master’s degree in health administration and is a fellow of the American College of Healthcare Executives. He was the assistant health commissioner for Cincinnati and has held health care executive positions in both the U.S. and Canada.

The TrueMajority OREO video... featuring an animated Ben Cohen.