By any measure, the United States spends an enormous amount of money on health care. Here are a few of those measures. In 2006, U.S. health care spending exceeded 16% of the nation's GDP. To put U.S. spending into perspective: the United States spent 15.3% of GDP on health care in 2004, while Canada spent 9.9%, France 10.7%, Germany 10.9%, Sweden 9.1%, and the United Kingdom 8.7%. Or consider per capita spending: the United States spent $6,037 per person in 2004, compared to Canada at $3,161, France at $3,191, Germany at $3,169, and the U.K. at $2,560.
By now the high overall cost of health care in the United States is broadly recognized. And many Americans are acutely aware of how much they pay for their own care. Those without health insurance face sky-high doctor and hospital bills and ever more aggressive collection tactics—when they receive care at all. Those who are fortunate enough to have insurance experience steep annual premium hikes along with rising deductibles and co-pays, and, all too often, a well-founded fear of losing their coverage should they lose a job or have a serious illness in the family.
Still, Americans may well underestimate the degree to which they subsidize the current U.S. health care system out of their own pockets. And almost no one recognizes that even people without health insurance pay substantial sums into the system today. If more people understood the full size of the health care bill that they as individuals are already paying—and for a system that provides seriously inadequate care to millions of Americans—then the corporate opponents of a universal single-payer system might find it far more difficult to frighten the public about the costs of that system. In other words, to recognize the advantages of a single-payer system, we have to understand how the United States funds health care and health research and how much it actually costs us today.
Paying through the Taxman
The U.S. health care system is typically characterized as a largely private-sector system, so it may come as a surprise that more than 60% of the $2 trillion annual U.S. health care bill is paid through taxes, according to a 2002 analysis published in Health Affairs by Harvard Medical School associate professors Steffie Woolhandler and David Himmelstein. Tax dollars pay for Medicare and Medicaid, for the Veterans Administration and the Indian Health Service. Tax dollars pay for health coverage for federal, state, and municipal government employees and their families, as well as for many employees of private companies working on government contracts. Less visible but no less important, the tax deduction for employer-paid health insurance, along with other health care-related tax deductions, also represents a form of government spending on health care. It makes little difference whether the government gives taxpayers (or their employers) a deduction for their health care spending, on the one hand, or collects their taxes then pays for their health care, either directly or via a voucher, on the other. Moreover, tax dollars also pay for critical elements of the health care system apart from direct care—Medicare funds much of the expensive equipment hospitals use, for instance, along with all medical residencies.
All told, then, tax dollars already pay for at least $1.2 trillion in annual U.S. health care expenses. Since federal, state, and local governments collected approximately $3.5 trillion in taxes of all kinds—income, sales, property, corporate—in 2006, that means that more than one third of the aggregate tax revenues collected in the United States that year went to pay for health care. (See Addendum below for information about how this estimate was calculated.)
Beyond their direct payments to health care providers and health insurance companies, then, Americans already make a sizeable annual payment into the health care system via taxes. How much does a typical household contribute to the country's health care system altogether? Of course, households pay varying amounts in taxes depending on income and many other factors. Moreover, some households have no health insurance coverage; others do have coverage for which they may pay some or all of the premium cost. What I aim to do here is to estimate the average size of the health care cost burden for households at different income levels, both those with job-based health coverage and those with no coverage.
Note that the estimates in the table below do not include out-of-pocket expenses. For those with health insurance, these include co-pays, deductibles, and uncovered expenses (consider, for example, that even my high-end policy does not cover commonly used home medical equipment such as oxygen). For those without insurance, of course, out-of-pocket expenses include their full hospital, doctor, and pharmacy bills.
See Appendix for further details of the calculations in the following.
The first row ("Share and Amount of Income Going to Health Care via Taxes Alone") shows how much of the total tax burden on households at three income levels goes into the nation's health care system. In other words, a family with an annual income of $50,000 that has no health insurance nonetheless contributes nearly 10% of its income to health care merely by paying typical income, payroll, sales, excise, and other taxes. A person who earns about $25,000 a year and has no health coverage already contributes over $2,400 a year to the system—enough for a healthy young adult to purchase a year's worth of health insurance.
The next two rows add in, for individuals and for families, the cost of employer-based health insurance. So, a household at the $50,000 income level with family health insurance coverage is paying over a quarter of its income into the health care system.
How were these figures derived? The tax component of the figures represents 34.4% of the total tax burden (federal, state, and local) on households at the three income levels. Of course, estimating average combined federal, state, and local taxes paid by households at different income levels is not a simple matter. The most comprehensive such estimates come from the Tax Foundation, a conservative think tank. Other analysts, however, including the liberal Center on Budget and Policy Priorities, view the Tax Foundation's figures as overestimating the total tax burden. The center has published its own estimates, based on figures from the Congressional Budget Office and Congress's Joint Committee on Taxation. The figures in the table are based on the CBO's numbers, which fall in between the Tax Foundation's estimates and the JCT-based estimates. (Estimates based on the Tax Foundation and JCT figures, along with details of the analysis, can be found at www.dollarsandsense.org.) It is worth noting that using the Tax Foundation's numbers, which show a larger share of income going to taxes at every income level, would have made the story even worse. For a family with health insurance earning $50,000 a year, for instance, the share of income going into health care would have been 28.7% rather than 26.4%.
For insurance premiums: in 2007, the average annual premiums for health insurance policies offered through employers were $4,479 for individuals and $12,106 for families, according to the Kaiser Family Foundation's annual survey of health benefits. Of course, some employers pay all or a large share of that premium while others pay half or less, leaving much of the premium cost to the worker. Either way, however, the full premium cost represents a bite taken out of the worker's total "wage packet"—the cost of wages plus benefits. This becomes evident when premiums go up: workers either see their own premium payments rise directly, or else face cuts or stagnation in their wages and non-health benefits. For that reason, economists typically view the entire premium as a cost imposed on the worker regardless of variations in employer contribution.
These figures are not meant to be exact, but do offer reasonable estimates of how much U.S. families are actually paying into the country's health care system today. Again, they do not include out-of-pocket expenses, which averaged 13.2% of all health care expenditures in 2005. Moreover, they do not include the risk of bankruptcy that health care costs impose: 50% of consumer bankruptcies in the United States stem from medical bills, including a surprising number among households that do have some kind of health coverage. Nor do they include the approximately 20% of auto insurance premiums or the 40% of workers' compensation premiums that pay for medical expenses.
More Taxpayer Dollars, Less Medical Research
The United States accounts for 51% of all global spending on medical research, according to a 2006 Global Forum for Health Research report. The report estimated that 60% of this is public funding, 8% comes from nonprofit institutions, and only 32% comes from the private sector. Even more important, most basic research—the research that undergirds most applied research and that requires long-term investment before any payoff can be expected—is heavily funded by the public.
That the United States spends the most money, however, does not necessarily mean that this country does the most research. U.S. heart surgeons charge twice as much as Canadian heart surgeons—or more—for the same coronary bypass operation, with no difference in morbidity or mortality. Likewise, U.S. taxpayers pay more for the same research. It isn't how much you pay, but how much quality research is carried out. When I lived in Canada and in Sweden, if I applied for a research grant for, say, $200,000, an additional circa 15% would be tacked on to cover administration of the grant and other so-called indirect costs. In the United States, the indirect-cost "surcharge" on a research grant to a university can range from about 50% at public universities up to 100% at private universities. Whereas in Canada and Sweden, libraries, computer centers, offices for grad students, and so on are included in university budgets, in the United States much of the funding for these basic facilities is drawn from the "overhead" line added on to grants. So, the same $200,000 research project would cost about $230,000 in Sweden or Canada, versus $300,000 to $400,000 in the United States.
Where Does All the Money Go?
After you've finished gasping in surprise at the share of your income that is already going into health care, you may wonder where all that money goes. One answer is that the United States has the most bureaucratic health care system in the world, including over 1,500 different companies, each offering multiple plans, each with its own marketing program and enrollment procedures, its own paperwork and policies, its CEO salaries, sales commissions, and other non-clinical costs—and, of course, if it is a for-profit company, its profits. Compared to the overhead costs of the single-payer approach, this fragmented system takes almost 25 cents more out of every health care dollar for expenses other than actually providing care.
Of the additional overhead in the current U.S. system, approximately half is borne by doctors' offices and hospitals, which are forced to maintain large billing and negotiating staffs to deal with all the plans. By contrast, under Canada's single-payer system (which is run by the provinces, not by the federal government), each medical specialty organization negotiates once a year with the nonprofit payer for each province to set fees, and doctors and hospitals need only bill that one payer.
Of course, the United States already has a universal, single-payer health care program: Medicare. Medicare, which serves the elderly and people with disabilities, operates with overhead costs equal to just 3% of total expenditures, compared to 15% to 25% overhead in private health programs. Since Medicare collects its revenue through the IRS, there is no need to collect from individuals, groups, or businesses. Some complexity remains—after all, Medicare must exist in the fragmented world that is American health care—but no matter how creative the opponents of single-payer get, there is no way they can show convincingly how the administrative costs of a single-payer system could come close to the current level.
Some opponents use current U.S. government expenditures for Medicare and Medicaid to arrive at frightening cost estimates for a universal single-payer health care system. They may use Medicare's $8,568 per person, or $34,272 for a family of four (2006). But they fail to mention that Medicare covers a very atypical, high-cost slice of the U.S. population: senior citizens, regardless of pre-existing conditions, and people with disabilities, including diagnoses such as AIDS and end-stage renal disease. Or they use Medicaid costs—forgetting to mention that half of Medicaid dollars pay for nursing homes, while the other half of Medicaid provides basic health care coverage, primarily to children in low-income households, at a cost of only about $1,500 a year per child.
Getting What We've Already Paid For
Americans spend more than anyone else in the world on health care. Each health insurer adds its bureaucracy, profits, high corporate salaries, advertising, and sales commissions to the actual cost of providing care. Not only is this money lost to health care, but it pays for a system that often makes it more difficult and complicated to receive the care we've already paid for. Shareholders are the primary clients of for-profit insurance companies, not patients. Moreover, households' actual costs as a percentage of their incomes are far higher today than most imagine. Even families with no health insurance contribute substantially to our health care system through taxes. Recognizing these hidden costs that U.S. households pay for health care today makes it far easier to see how a universal single-payer system—with all of its obvious advantages—can cost most Americans less than the one we have today.
Joel A. Harrison, PhD, MPH, lives in San Diego, where he does consulting in epidemiology and research design. He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. He has lived and studied in both Canada and Sweden.
ADDENDUM
A Tax Foundation report states, "In 2004 Americans paid a total of $3 trillion in total taxes." The U.S. Bureau of Economic Analysis under its National Economic Accounts section gives the following numbers for U.S. Gross Domestic Product in billions of dollars: 2004 - $11,685.9 and 2006 - $13,194.7. Using the Tax Foundation tax estimates, the estimated tax percentage of GDP for 2004 was 25.67% ($3 trillion/$11.6859 trillion). The "$3.5 trillion" is a ballpark rounding estimate for total taxes for 2006 from multiplying 0.26 by the 2006 GDP.
See Appendix for further details of the calculations on which this article is based.
Health Care: Go Canadian - U.S. should adopt its northern neighbor’s system..Pro or con?
Category: News and Politics
Health Care: Go Canadian.
The U.S. should adopt its northern neighbor's system of state-paid medical care for all its citizens. Pro or con?
Pro: Follow the Maple Leaf by James Clancy, National Union of Public & General Employees (Ottawa) Business Week
I find Top 10 lists are a useful way to quickly distill large and complicated issues down to the bare essentials. So here are my Top 10 reasons the U.S. should adopt Canada's single-payer health-care system.
1. All Americans would have health insurance. This is the right thing to do because it reflects and promotes core values and notions of citizenship: equality, compassion, and social solidarity. Sickness doesn't discriminate. Neither should health care.
2. Health would improve. On almost every critical measure (life expectancy, infant mortality, etc.), Canada rates higher than the U.S., and we're among the best in the world.
3. It would cost less. Canada spends 9.8% of GDP on health care, while the U.S. spends more than 15%. A single-payer system is the less expensive way to go.
4. Patients would have more choice. In Canada, patients can choose whatever doctor, specialist, and hospital they want. Treatment decisions are left to patients and their doctors. No insurance companies meddle in our choices.
5. Quality of service would improve. In Canada, health providers never have to choose between their wealth and a patient's health. Our system forbids that choice. The vast majority of Canadians are highly satisfied with the quality of care they receive. In Canada, patients rarely sue physicians.
6. It would reduce the bureaucracy. Patients in Canada show their health card and get care. Health providers bill the government directly and get paid. It's that simple.
7. Fewer Americans would go bankrupt because of health-care costs. This is a major problem for many U.S. families. It rarely happens in Canada.
8. It would benefit business. Companies in Canada have a competitive advantage because they don't have to provide basic health-care coverage for their workers.
9. It would diminish labor strife. Health care is incidental in labor negotiations in Canada. It's a large and growing pitfall in contract negotiations in the U.S.
10. It would serve democracy. Most Americans want major, not incremental, health-care reform. Many Americans support a single-payer system. It is about responding to the wishes of the people.
It's not that I think Canada's national health-care system is a bad one. But I don't think we should lift any one country's health-care system to replace the one in the U.S. that is so damaged and dysfunctional.
Canada's system is not without its detractors. The complaints range from long waiting times to dramatic inconsistencies of care depending on the province one lives in. There are so many caffeinated critics of changing to "socialized medicine" in the U.S. that, even if the system we convert to isn't actual socialized medicine, Canada's well-chronicled complaints would provide ammunition for the status quo crowd.
Instead, a new Administration in Washington should put together a bipartisan commission to study, with a deadline, the systems around the world that spend less on health care than the U.S. but get better results. In the end, there would be a "best of all worlds" solution that both major political parties would have played a part in building.
The biggest complaint, and often the myth, of nationalized systems is that everyone has inordinate waiting times for surgeries and treatments. In some countries, this has held true. At one point in Canada, residents of Saskatchewan waited two years for an MRI. But in Japan, there is virtually no waiting. In Germany, wait times for surgeries can be a few weeks, just like in the U.S. In Britain today, hip and knee replacements happen within three months of the asking. That's faster than I was able to get one in the U.S.
The U.S. system needs four major overhauls, and we should cherry-pick from Britain, Germany, Japan, Switzerland, and Taiwan, to name a few, to find the right structure for each fix.
1. Medical insurance must convert to a nonprofit enterprise.
2. Prices for medical procedures and drugs must be negotiated each year, and fixed at one price by the government, insurance companies, and health-care providers.
3. Medical malpractice awards must be limited and set the same way drug and treatment costs are, rather than battled out in court one by one.
4. Medical records and billing must convert to "smart cards" to spare patients unconscionable administrative costs and paperwork.
It will take leadership and courage in Washington to stand up to special interests like trial lawyers and global drug companies and medical-device makers who are invested in the skyrocketing costs of U.S. health care as a way of subsidizing the sounder, fairer systems around the world.
Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.http://www4.law.cornell.
MRS. J. LOOKED baffled and hurt. I had just explained that I would no longer be her primary care doctor. I was leaving the field after just three years. "I have had three different primary care doctors over the past 10 years," she said. "You can't leave now. I was just starting to feel comfortable. I am getting older now. I can't keep changing doctors!"
Primary care is in crisis. Current primary care doctors are quitting, and medical students are pursuing other specialties. Primary care has lost its attractiveness as a profession because of poor compensation and plummeting job satisfaction. Primary care physicians are in short supply, and in Massachusetts, this problem has intensified in the wake of healthcare reform, as more than 300,000 previously uninsured individuals have joined in the search for available doctors.
As a former primary care physician, I am most troubled by the antagonistic state of the patient-doctor relationship. The system sets us against each other. Like many in the field, I chose primary care because I love people. I wanted to take care of the whole person, body and mind. I wanted the intimacy that comes with knowing your patients well and following them over many years. These goals are difficult to achieve in primary care today. After two years in my practice, I walked into an exam room one day and introduced myself to a patient. "We have met before," she replied, clearly aggravated. I was horrified and saddened.
Patients are angry, and rightly so. They feel frustrated by the inability to get timely appointments with their physicians, rushed by the 15-minute visits and the seemingly harried doctors, ignored when they do not receive letters with lab results or follow-up phone calls. They feel disrespected when they come to their medical appointments on time and then sit in the waiting room for 45 minutes. All of these feelings are justified. We are not offering high-quality care.
Doctors feel angry, too. We have too many patients. It is not uncommon for a full-time primary care doctor to have upwards of 3,000 patients. It is impossible to know all of these individuals well, to give adequate focus to each person's unique situation, to sift through the piles of paperwork and lab data daily. Our days are divided into 15-minute sessions, back to back. We move frantically from exam room to exam room, trying desperately not to fall behind in our schedule. We are given incentives to see patients as quickly as possible. We live in fear of litigation.
We are drowning, and in this overwhelmed state we lose our ability to take good care of people. Outwardly, we may feel resentful and burdened. Underneath, many of us feel loss, deep sadness, and personal failure.
This rift between patient and doctor is painful and destructive to the core of medicine: the therapeutic relationship. In an environment where patients and doctors don't know each other well and appointments are rushed, it is inevitable that more medical errors occur and that resources are wasted as expensive tests are substituted for communication. By contrast, research indicates that medicine practiced in the context of solid primary care relationships allows for earlier detection of chronic diseases, and, ultimately, better outcomes and monetary savings, to say nothing of patient and doctor satisfaction
In this election year, patients and doctors need to come together to support healthcare reform aimed at revitalizing primary care. To begin, our medical reimbursement system must be restructured. Our payment system values invasive treatments and procedures over time spent talking with your doctor. We need to reset these compensation levels to favor communication, care coordination, disease prevention, and chronic disease management. Doctors should be rewarded for keeping patients well. Incentives should be based on quality outcomes and efficient resource use, not on patient volume.
Most important, primary care physicians should be valued as team leaders and advocates, poised to help patients navigate the complex medical system. There is no reason why so many patients like Mrs. J. need to feel lost and abandoned in a country that spends far more on healthcare than any nation in the world.
Dr. Annie Brewster is an urgent care physician at Massachusetts General Hospital.
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Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.http://www4.law.cornell.
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.
"It made no sense," said Ms. Robertson, 39, who lives in Centennial, Colo. "I'm in perfect health."
She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.
Ms. Robertson had been shopping around for individual health insurance, the kind that people buy on their own. She already had insurance but was looking for a better rate. After being rejected by Golden Rule, she kept her existing coverage.
With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person's medical history. Sometimes, a past Caesarean means higher premiums.
Although it is not known how many women are in Ms. Robertson's situation, the number seems likely to increase, because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily — and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.
"Obstetricians are rendering large numbers of women uninsurable by overusing this surgery," said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.
Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy's group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.
"You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other," Ms. Udy said.
Insurers' rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America's Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.
"Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time," Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.
"In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward," Ms. Pisano said.
Her group has reported that although most Americans with health insurance, 160 million, have group plans through employers, the number needing individual policies will probably keep rising, because more and more people are becoming self-employed or taking jobs without health benefits.
In a letter to Ms. Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule simply rejects women who have had the surgery, unless they have been sterilized or meet the company's age requirements.
"If you don't work for someone who has insurance, and you have to get insurance on your own, this is terrifying," Ms. Robertson said.
A spokeswoman for Golden Rule declined to explain how long it had been excluding Caesareans, how it had decided to do so or how many were affected, saying the information was proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most with group coverage.
In Colorado, people denied individual health insurance can obtain it through a state program, Cover Colorado, which insures about 7,200 people. But the premiums are high, 140 percent of standard rates, a spokeswoman said, adding that some women had enrolled specifically because prior Caesareans had disqualified them from private insurance.
Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized.
"After five years, if there is not a complication of pregnancy, another C-section, or if they get their tubes tied and are no longer in that risk situation, that rate-up goes away," said Randy M. Kammer, the vice president for regulatory affairs and public policy.
The higher rate is based on a Caesarean costing an average of $2,700 more than a vaginal birth (assuming no complications in either type of delivery). Ms. Kammer said Blue Cross Blue Shield could not provide a tally of how many members were paying the higher rates because of Caesareans.
"The aggravating thing is, there are a lot of elective Caesareans, and that adds to costs," she said.
Elizabeth Bonet, who lives in Sunrise, Fla., learned about the higher rates this year when she applied to Blue Cross Blue Shield of Florida.
"I was very angry, outraged, shocked," Ms. Bonet said. "It made me feel very helpless. These were not Caesareans I wanted. They were not elective Caesareans. I very much wanted natural births with both babies and was not able to have them, and to have to pay for that for years is outrageous, and I feel it's discriminatory as well."
Each state's Blue Cross Blue Shield plan sets its own policies. In Texas, a spokeswoman said, a prior Caesarean will not affect a woman's premiums or insurability, as long as she has recovered fully.
A spokeswoman for another major insurer, Wellpoint, said the company's decisions about prior Caesareans varied case by case, but declined to explain further.
Aetna does not treat a Caesarean itself as a pre-existing condition, but does factor in chronic or recurring problems that might have led to the Caesarean, like diabetes or high blood pressure, a spokeswoman said.
A spokeswoman for another company, Mega Life and Health Insurance, in North Richland Hills, Tex., said: "If the Caesarean section was considered by the physician to be medically necessary for the safety of the mother or child then coverage is issued without conditions. If the procedure was determined to be 'elective,' coverage would be offered with a temporary waiver or at a higher premium rate."
Insurers often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience — to deliver the baby at a certain time, or to avoid labor. But it is not known how much of the overall increase in Caesareans is because of a rise in unnecessary operations, or how many Caesareans are done at the mother's request, according to a 2006 report by the National Institutes of Health.
"I think it's really a very small amount, but we need more data," said Dr. Mary D'Alton, chief of obstetrics and gynecology at Columbia University Medical Center, and an author of the report.
She said she was amazed to hear that insurers would charge higher premiums or deny coverage because of a past Caesarean.
"I would think if it's happening, the medical profession has to take a stand," Dr. D'Alton said.
But to people familiar with the rough and tumble world of individual insurance, the companies' practices are no surprise.
Individual insurance differs sharply from the group coverage with which most people are familiar. Group policies generally require that the insurer cover everybody in the group, and charge the same rates for all. But with individual coverage, insurers in many states can vary their prices based on medical history, exclude certain services or reject anyone they consider a bad risk. (Several states, however, including New York, New Jersey and Massachusetts, ban such practices.)
Insurers say they need these strategies to protect themselves, because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses.
Ms. Robertson said that had she known a Caesarean was grounds for rejection, she would not have even applied to Golden Rule, because the denial may be held against her in the future. Insurers routinely ask applicants if they have ever been denied, and red-flag anyone who says yes.
"My understanding is that once you're denied it's hard to get other insurance," Ms. Robertson said. "Man, is that a scary thing."
Material appearing here is distributed without profit or monitory gain to those who have expressed an interest in receiving the material for research and educational purposes. This is in accordance with Title 17 U. S. C. section 107.http://www4.law.cornell.
Comment:So the private health insurance companies "will not sacrifice profitability for membership." Yetthe presidential candidates insist on keeping this industry in charge. Whose arrogance is this?
Health Affairs excludes single payer - Optimists, get up and change the political dynamic!
Category: News and Politics
An archived webcast of an event coinciding with the release of the following issue of Health Affairs, which focuses on health reform (the panel excludes representatives of single payer reform):
Ouch! In this special issue of Health Affairs, we hear once again that the politics of reform requires compromise. The current political dynamic moves forward with the assumption that a single payer national health program represents an uncompromising position on health policy that ignores political realities. That may be true, but does that warrant the exclusion of consideration of policies that would improve the efficiency, equity and affordability of health care merely because the political alignment is not yet optimum?
It is notable that the editors did allow one almost parenthetical sentence mentioning, "with some risk," the simplicity of achieving goals of reform through a single payer system.
Politics alone is not a reason to exclude superior health policies from consideration, but when the political process does have that result, it is our obligation to do everything that we can to change the politics. Politics is a dynamic, and it is malleable.
New York Times columnist Thomas Friedman, in a tribute to his mother this weekend, wrote, "...every time life knocked her down, she got up, dusted herself off and kept on marching forward, motivated by the saying that pessimists are usually right, optimists are usually wrong, but most great changes were made by optimists."
Optimists, get up and change the political dynamic!
McCain Plan: Millions Lose Coverage, Health Costs Worsen and Insurance & Drug Industries Win
Category: News and Politics
The McCain Health Plan: Millions Lose Coverage, Health Costs Worsen, and Insurance and Drug Industries Win By Roger Hickey Campaign for America's Future
Tuesday 29 April 2008
Today Arizona Sen. John McCain will deliver what his handlers are hyping as a major address on health care. McCain's plan is a dangerous fraud.
He wants voters to think he is going after health care cost inflation. In reality, he wants to dismantle the employer-provided system that now covers over 60 percent (or about 158 million) of non-elderly Americans, forcing millions of us who now get fairly decent health insurance on the job to instead buy whatever they can find on the individual market controlled by unregulated and predatory insurance companies. And he would drive health care costs upward, not downward.
This is truly amazing: McCain and his handlers knew they had to say something about health care. So they turned to their friends (and financial supporters) in the health care industry and the conservative think tanks. And they have adopted the most extreme right-wing ideological approach, premised on the idea that the big problem in health care is that Americans have too much insurance - in their words, we don't have enough "skin in the game" - and that only when we have to buy health care with money that comes directly out of our own pockets will consumers force doctors, hospitals and insurance companies to become more efficient.
So that's the theory. But it is contradicted by the facts. Most of us already pay part of our premiums out of our own pockets, and we increasingly have to shell out for co-pays in order to get to see a doctor. The result - in practice - is that most people, even those with good insurance, now think twice or three times about even getting regular preventive health checkups. Having lots of "skin in the game" has meant that millions of Americans don't get health care they need - and that's one of the big problems in U.S. health care driving costs up, not down.
But McCain, like George Bush, pays more attention to ultra-conservative theory than he does to the facts. So McCain wants to tax workers' health care premiums that are paid for by employers. Ask any expert, conservative or liberal, and they will tell you the result will be companies will stop providing health care as an employee benefit. Fortune Magazine quotes one of their experts on the impact of McCain's plan: "I predict that most companies would stop paying for health care in three to four years," says Robert Laszewski, a consultant who works with corporate benefits managers.
Now keep this in mind: McCain and his corporate advisers don't dispute this. The massive upheaval that would result - millions of families losing their health coverage on the job and then having to try to find an insurance company that would sell them a new policy that would cover their families - that's not an unintended consequence of his proposal. That chaotic loss of health security is exactly what McCain intends to happen. He wants us all to buy insurance not as part of a group - like an employee group or a co-op - that can negotiate for better coverage at lower premiums, but as individuals, at the mercy of the private insurance companies.
And get this: McCain wants to abolish the regulations that currently exist in most states that require companies to insure people with pre-existing conditions, provide benefits that don't exclude some medical conditions, and prevent them from charging huge premiums for crumby benefits. How would he do this? By "giving people the freedom" to buy insurance in other states with weaker regulations. You can bet that most of the big insurance companies are now shopping around for the state that wants to become the corporate headquarters state for the new deregulated health insurance industry - if President McCain wins. Delaware? Mississippi? Arizona?
But, but, but ... I can hear some people saying, McCain does give people refundable tax credits to help pay for health insurance. And that is part of his package. But his whole philosophy is that too many millions of American's are getting health care benefits that are too rich, and you certainly can't say that about the level of tax subsidy he would provide - $2,500 per year for individuals and $5,000 for a family, according to the McCain for President website. Last year the average yearly cost of the most popular type of insurance plan offered by employers hit $11,765, according to a Kaiser Family Foundation study. So the average person with a family would end up paying $11,765 minus the $5,000 tax credit, or $6,765 - about double the $3,226 Kaiser tells us the average employee paid for his or her share of premiums.
Again, this is NOT unintentional. McCain and his corporate advisers think it is good for individuals and families to pay more because it makes them think twice before seeking health care, and - in theory - they will shop around for cheaper care. And if they can't cover the costs of real health insurance with McCain's tax credit, the insurance industry will sell you lower-cost plans with big holes in coverage or costly co-pays - that is, if you are not already sick and you aren't too old for them to see you as profitable.
And McCain will be glad to help you invest your tax credit in a Health Savings Account - a savings account coupled with an insurance plan cooked up by his friends in the insurance industry with such high deductibles that it only applies for catastrophic health costs. For those normal trips to the doctor, you just take money out of the savings account until there is nothing left - and then you really reduce health care costs by forgoing the trip to the doctor altogether.
The ultra-conservatives have a name for this combination of tax credits and HSAs. They call it "consumer-directed health care." A better name is "high-cost health care" - or "insurance company-directed health care." And although they promote it as saving money for individuals, for our economy and our society, the available evidence shows that it does nothing to reduce health care costs - but it will leave millions of people with worse coverage, more chronic health problems, and higher levels of health cost-driven bankruptcies. And, perhaps most importantly for McCain's financial backers, it would leave the insurance industry and the drug industry even more in control of America's health care system than ever before.
The release of this McCain health care plan is an important test for the mainstream media. Health care experts who are "reality-based" will, if asked to comment, tell reporters that there is no evidence that McCain's proposals will do anything to reduce health care costs, but will the media fall for the McCain spin?
Here's the story they would like major media to report:
"While Democrats Obama and Clinton, stuck in an endless primary contest, fight with each other over who would cover more of the uninsured, John McCain has been using the luxury of uncontested time to develop a thoughtful plan for bringing down health care costs - the issue voters care most about when it comes to their own family budget worries. And McCain's plan would attack the health cost spiral by unleashing the power of individual consumers and families in a more competitive health care marketplace, not by using the power of the federal government to either provide health care and not by dictating health insurance arrangements between workers and employers. Expanding consumer choice - and encouraging health care consumers to be wise purchasers of health care, said McCain, is the best way to force the health care system to become more efficient and reduce the burden of health care costs."
Most honest reporters will note that the McCain will not improve the lot of America's 47 million uninsured, but they may give McCain credit for focusing more ..ling prices than Obama and Clinton. That might sound "fair and balanced" - but it would be wrong.
The reality is, McCain's proposals would greatly increase the number of uninsured Americans, while also doing nothing about health care costs except increasing the number of people who can't afford good quality health care for themselves and their families. Let's see if the media gets both parts of the story right.
From Dr. Don McCanne 4/18/08:
The political rhetoric of "socialized medicine"
Harvard School of Public Health
February 14, 2008
Poll Finds Americans Split by Political Party Over Whether Socialized Medicine Better or Worse Than Current System
A poll by the Harvard Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive:
Q. So far as you understand the phrase, do you think that if we had socialized medicine in this country that the health care system would be better or worse than what we have now?
With health reform at the forefront of the national campaign, some charge that proposals to restructure our health care system represent dangerous steps moving the country towards government-run health care and socialized medicine. Similar rhetoric was heard last fall when President Bush vetoed legislation reauthorizing the State Children's Health Insurance Program (SCHIP). We find this rhetoric inapplicable to both the SCHIP bill and proposals from most presidential candidates. The core issues in health reform involve, not the size of government, but proposals' effect on the number of uninsured, access to quality care, cost growth, and consumers' health care choices.
The U.S. Health Care System Today
Medicaid and Medicare cover 42.7 million and 42.4 million people, respectively, with some poor seniors and people with disabilities receiving coverage from both programs. The government also provides publicly funded health care to almost 9 million current and former federal employees and dependents through the Federal Employees Health Benefits Program; 3.7 million veterans who receive health care through the VA; and the country's active-duty soldiers and their dependents. Only 5 percent of the insured population in the United States does not receive some kind of government subsidy, either directly or through a tax benefit.
Pending Proposals for SCHIP and National Reforms
Some single-payer proposals would go much further; an example is that advanced by Congressman Kucinich (HR 676). While health care providers would nominally remain private, the government's authority would be so all-encompassing that the system would be the functional equivalent of socialized medicine.
Market-Oriented Proposals
Proponents of these market-oriented proposals agree that a strong public-sector role is appropriate if it accomplishes important objectives. That is why these proposals retain most functions served by government today and, in some cases, embrace aggressive new government interventions.
Many market-oriented proposals would create problems of quality and access to care for some people — the very problems some argue are characteristic of publicly run systems.
Conclusion
The core issue in health reform is not specifically the role of government, but what policies yield the best possible consequences for the American public. Such results include the number of people with health coverage, consumers' quality of and access to necessary care, health care cost growth, and consumers' ability to make choices about their health care and health coverage. Rhetoric about socialized medicine and government-run health care is a distraction from these much more fundamental concerns.
Comment: For political reasons efforts often are made to obfuscate the definition of "socialized medicine," but it is important to understand the meaning of the term. A socialized medicine system is one in which the government is the owner of the health care delivery system, and professionals providing the health care are employees of the government.
In contrast, social insurance is a government insurance program which pays for health care provided by the private health care delivery system. Social insurance programs may be government-administered programs, such as the single payer model, or they may be contracted through private insurers. Do not confuse these private, non-profit insurers in social insurance programs with the model of for-profit private insurance in the United States. The private insurers in social insurance programs serve primarily as administrators, but the tightly-regulated financing system functions basically like the single payer model.
The Veterans Administration health system is government owned, and the professionals within the system are employees of the government. Thus it is a system of socialized medicine. Medicare is a government insurance program that pays for services in the private health care delivery system. Thus it is a program of social insurance.
Even Americans who believe they understand the term "socialized medicine" are often confused. In the Harvard/Harris poll, only 47 percent believe that the veterans health care system is a system of socialized medicine (it is). In contrast, 60 percent believe that Medicare is a system of socialized medicine (it is not).
Stan Dorn and John Holahan from the Urban Institute warn us that "rhetoric about socialized medicine and government-run health care is a distraction." Yet they state that the single payer proposal of HR 676 "would be the functional equivalent of socialized medicine." Well, they do have an agenda. They state that policies yielding the best consequences for the American public would include "consumers' ability to make choices about their health care and health coverage." Throughout their report are many other comments that make it clear that they support the Clinton/Obama model of choice of private insurance plans while rejecting the single payer model. It's clear that they want to insulate the Democrats' proposal against the inevitable "socialized medicine" attack of the Republicans. (It should be noted that the Republicans' claim of private market solutions rings hollow when they propose expanding government subsidies to a population in which 95 percent of the insured are already receiving some form of public subsidies.)
We must continue to stand up against those who obfuscate the issues by abusing the political rhetoric over socialized medicine, especially so when they come from our own camp. They are correct when they say that it is the policies that count, but they are wrong when they reject policies, for political reasons, that would provide the greatest benefit for the patients.
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My Vote’s for Obama (if I could vote) ...by Michael Moore
Category: News and Politics
My Vote's for Obama (if I could vote) ...by Michael Moore
April 21st, 2008
Friends,
I don't get to vote for President this primary season. I live in Michigan. The party leaders (both here and in D.C.) couldn't get their act together, and thus our votes will not be counted.
So, if you live in Pennsylvania, can you do me a favor? Will you please cast my vote -- and yours -- on Tuesday for Senator Barack Obama?
I haven't spoken publicly 'til now as to who I would vote for, primarily for two reasons: 1) Who cares?; and 2) I (and most people I know) don't give a rat's ass whose name is on the ballot in November, as long as there's a picture of JFK and FDR riding a donkey at the top of the ballot, and the word "Democratic" next to the candidate's name.
Seriously, I know so many people who don't care if the name under the Big "D" is Dancer, Prancer, Clinton or Blitzen. It can be Mickey Mouse, Donald Duck, Barry Obama or the Dalai Lama.
Well, that sounded good last year, but over the past two months, the actions and words of Hillary Clinton have gone from being merely disappointing to downright disgusting. I guess the debate last week was the final straw. I've watched Senator Clinton and her husband play this game of appealing to the worst side of white people, but last Wednesday, when she hurled the name "Farrakhan" out of nowhere, well that's when the silly season came to an early end for me. She said the "F" word to scare white people, pure and simple. Of course, Obama has no connection to Farrakhan. But, according to Senator Clinton, Obama's pastor does -- AND the "church bulletin" once included a Los Angeles Times op-ed from some guy with Hamas! No, not the church bulletin!
This sleazy attempt to smear Obama was brilliantly explained the following night by Stephen Colbert. He pointed out that if Obama is supported by Ted Kennedy, who is Catholic, and the Catholic Church is led by a Pope who was in the Hitler Youth, that can mean only one thing: OBAMA LOVES HITLER!
Yes, Senator Clinton, that's how you sounded. Like you were nuts. Like you were a bigot stoking the fires of stupidity. How sad that I would ever have to write those words about you. You have devoted your life to good causes and good deeds. And now to throw it all away for an office you can't win unless you smear the black man so much that the superdelegates cry "Uncle (Tom)" and give it all to you.
But that can't happen. You cast your die when you voted to start this bloody war. When you did that you were like Moses who lost it for a moment and, because of that, was prohibited from entering the Promised Land.
How sad for a country that wanted to see the first woman elected to the White House. That day will come -- but it won't be you. We'll have to wait for the current Democratic governor of Kansas to run in 2016 (you read it here first!).
There are those who say Obama isn't ready, or he's voted wrong on this or that. But that's looking at the trees and not the forest. What we are witnessing is not just a candidate but a profound, massive public movement for change. My endorsement is more for Obama The Movement than it is for Obama the candidate.
That is not to take anything away from this exceptional man. But what's going on is bigger than him at this point, and that's a good thing for the country. Because, when he wins in November, that Obama Movement is going to have to stay alert and active. Corporate America is not going to give up their hold on our government just because we say so. President Obama is going to need a nation of millions to stand behind him.
I know some of you will say, 'Mike, what have the Democrats done to deserve our vote?' That's a damn good question. In November of '06, the country loudly sent a message that we wanted the war to end. Yet the Democrats have done nothing. So why should we be so eager to line up happily behind them?
I'll tell you why. Because I can't stand one more friggin' minute of this administration and the permanent, irreversible damage it has done to our people and to this world. I'm almost at the point where I don't care if the Democrats don't have a backbone or a kneebone or a thought in their dizzy little heads. Just as long as their name ain't "Bush" and the word "Republican" is not beside theirs on the ballot, then that's good enough for me.
I, like the majority of Americans, have been pummeled senseless for 8 long years. That's why I will join millions of citizens and stagger into the voting booth come November, like a boxer in the 12th round, all bloodied and bruised with one eye swollen shut, looking for the only thing that matters -- that big "D" on the ballot.
Don't get me wrong. I lost my rose-colored glasses a long time ago.
It's foolish to see the Democrats as anything but a nicer version of a party that exists to do the bidding of the corporate elite in this country. Any endorsement of a Democrat must be done with this acknowledgement and a hope that one day we will have a party that'll represent the people first, and laws that allow that party an equal voice.
Finally, I want to say a word about the basic decency I have seen in Mr. Obama. Mrs. Clinton continues to throw the Rev. Wright up in his face as part of her mission to keep stoking the fears of White America. Every time she does this I shout at the TV, "Say it, Obama! Say that when she and her husband were having marital difficulties regarding Monica Lewinsky, who did she and Bill bring to the White House for 'spiritual counseling?' THE
