Progress Now Action

A study published in Health Affairs (6-10-08) documents a sharp (60%) increase in numbers of underinsured between 2003-2007. Underinsurance rates nearly tripled among those with incomes above 200% of poverty. Consequently, 42 percent of U.S. adults were under- or uninsured in 2007, reporting high levels of access problems and financial stress.

Even among those with incomes over 400% of poverty, 15% are underinsured. The study indicates that the move toward greater consumer cost-sharing for minimum benefit insurance policies in recent years is pushing millions of insured non-elderly adults toward spending large shares of their incomes on health care. The clear impact is to increase the share of families at risk for medical debt and loss of savings for retirement, college, or other long-term needs.

Our current insurance system is working well only for the wealthy, who can afford high costs. Politicians' promises that "you can keep the insurance you have" also apply to the wealthy.  Read the Report

Following is a 650-word piece I wrote about the failure of profit-centered health care that has been picked up by several newspapers around the state.

                              Failure of U.S. profit-centered health insurance

Spending almost twice as much, the U.S. has worse health outcomes than other industrialized nations. Uniquely, U.S. health care is dependent on over 1200 for-profit health insurances, functioning as gatekeepers. Underwriting – the art of risk evaluation and avoidance – insures profits by covering the healthy and rejecting everyone else as a "pre-existing condition."

Profit is a perverse incentive for quality health care: imagine for-profit fire or police protection. "Market-driven" health care treats health as a commodity, to be negotiated like a car or a house. The free market has also spawned "designer hospitals," offering only the most profitable specialties, e.g., cardiac procedures, and eliminating less profitable services, e.g., emergency and mental health.

No reform proposal by current presidential candidates addresses the failure of the private health insurance industry, characterized principally by decreasing benefits and greater costs and risks shifted to consumers. In turn, more are subjected to underinsurance and unpaid medical bills – now the leading cause of personal bankruptcies. Premium increases of 87 percent over 6 years have outpaced both cost-of-living and median family income increases.

Incremental reform proposals demonstrate lack of political will – the same failure to confront corporate profit-taking by insurance and pharmaceutical industries that wrote Medicare prescription drug reform with billions of dollars of taxpayer subsidies and inflated profits to benefit their bottom lines.

Commercial health insurance is the 800-pound gorilla, responsible for over 25% of health care dollars siphoned to excessive administrative costs, lobbying, marketing, CEO salaries and profit-taking: $30 billion annual health insurance profits; $32 billion insurance underwriting and marketing costs (McKinsey Group, 2007).

Gaming the system for profit has given rise to the annual $20 billion business of "denial managment" – health insurance middlemen who search claims for excuses to delay, deny or renege on reimbursements.

Responding to double-digit premium increases, more employers are opting to move employees into underinsurance – high-deductible catastrophic plans. Simultaneously, the American Hospital Association reports that both family out-of-pocket health expenses and unpaid medical bills have risen approximately 60% over a decade – still more costs ultimately shifted to taxpayers and consumers.

Notably, more than 20 federal and state studies since 1990, including the 2007 Lewin Group evaluation in Colorado, have demonstrated that single-payer health insurance is the only reform model that can both save money and provide comprehensive health care benefits for all. Indeed, the single payer model is the only truly efficient, equitable, and sustainable financing system, enabling universal coverage by spreading risk across the entire population.

Contrary to assertions by the "free market" choir, only single payer insurance permits true choice of pubic and private providers; private insurance is limited to "in plan" doctors. Only single payer provides comprehensive benefits and protection against medical bankruptcy.

Rather than comprehensive health care reform, most current proposals revert to a Massachusetts-style nostrum, preserving insurance profits and requiring an individual mandate to purchase minimum-benefit insurance, subsidized by taxpayers as needed. It is a formula for continued inflationary consumer health costs and decreasing benefits.

National single payer bill, HR676, calls for a progressive 3 to 4 percent employer and employee payroll tax to replace all health deductibles and premiums. Full-coverage costs for a family of four earning $40,000 annually would drop to $110 a month, from recent levels of $273/month for employer-sponsored coverage, or $489/month for an individually-insured family (Kaiser Family Foundation, 2007).

A political class dependent on corporate money (and privy to 70 percent-taxpayer-subsidized health coverage) sidesteps meaningful reform. Nevertheless, polls by Pew and others have revealed increasing numbers – 54 to 65 percent of people – support a national single-payer health care plan. A recent survey reports that 59 percent of U.S. physicians now support national health care, up 10 percent from 2002.

A grassroots movement and political reforms, including publicly-financed campaigns, may be necessary to instill the political will for meaningful reform. We have everything to gain from quality-, saftey-centered universal single payer health care to replace U.S. dependence on profiteering health care gatekeepers.

CheneyCare -- We taxpayers pay 70% of guaranteed coverage for VP Dick Cheney and 2 million federal legislators and employees. 
Link: Bill Moyers' Journal 5/9/08 -- California Nurses' campaign for "CheneyCare" for all.  Read transcript or view program: http://www.pbs.org/moyers/journal/05092008/transcript1.html


Video "Who the Health Cares?" gets straight to the point: Presidential candidates will not determine health care reform -- the ball is in the court of Congress. http://www.moblogic.tv/video/2008/04/30/who-the-health-cares/


For-Profit Health Insurance and Pharmaceutical Industries -- scary statistics

1) Melody Peterson's book "Our Daily Meds" reveals that the benefit of medicines marketed by pharmaceutical companies "has become secondary to how much it will bring shareholders in profit"...due to constant pressure by Wall Street for drug companies to exceed profits made the year before; Big Pharma employs 2 lobbyists for every Congress member.

2) Tests show that placebos often work as well as the drugs being marketed to the public.

3) 100,000 Americans die annually from taking prescribed drugs as prescribed (FDA reports).

4) U.S. experiences 75,000-100,000 preventable deaths annually, ranking 19 out of 19 nations. (Recent study, Ellen Nolte & Martin McKee, London School of Hygiene & Tropical Medicine) 

Please join Be the Change-USA & Health Care for All Colorado
for an exciting, engaging and fun event May 31

Are We All Really Covered? Closing the Gaps in Health Care
12 noon - 7:30 PM, Sat., May 31, 2008

First Plymouth Congregational Church
3501 S. Colorado Blvd. (Hampden and Colorado Blvd)
Englewood, CO

Registration: Full program: $35; Dinner & evening speakers: $25; Evening speakers only: $10. Discount for Seniors, students, veterans, BTC and HCAC members: $5

Special program features:
1-3 PM Providers and Patients Panel: "How did we get into this mess, and how can we get out?"

3-5 PM Presentations by CO elected officials and candidates: "Will Colorado begin to close the gap?"

5 PM Dinner "Legislative Grill" -- Members of Congress and candidates and representatives of Presidential campaigns: "Will Congress or our next President begin to close the gap?"

6 PM Evening Keynote speaker: Elizabeth Kucinich

More info: www.BTC-USA.org or www.healthcareforallcolorado.org or call Dick Barkey, 303-808-8504, or Eliza Carney, 970-416-0636
To register online: www.BTC-USA.org  

The U.S. spends on average twice as much on health care as other industrialized nations, and has overall worse outcomes. Paul Krugman’s & Robin Wells’ commentary ("The Health Care Crisis and What to Do About It," The New York Review of Books, 3/23/06) attributes the U.S. health care crisis to high dependence on fragmented, for–profit private insurances, hospitals and numerous middlemen that add health costs without adding value. Noting "the strange persistence, in the teeth of all available evidence, of the belief that the private sector can provide health insurance more efficiently than the government," Krugman and Wells remark that free-market ideology is "wholly inappropriate to health care issues." As many observe, health is not a commodity, like a car or house.

Factors of declining U.S. health care:

•      -Washington and the Bush administration are in thrall to insurance and drug industry lobbyists.
•      -The privatization-for-profit increases the fragmentation of U.S. health care, swelling the ranks of the uninsured.
•      -Commercial insurance has abandoned the principle of shared risk, shifting more risk to consumers, and has adopted the principle of adverse selection to guarantee profits for shareholders.
•      -Private insurances continue to skim over 20 percent of costs for profit and CEO salaries.

Employer-provided health coverage is unraveling, as U.S. health costs rise twice as high as inflation and 4 times faster than wages, prompting more employers to reduce/eliminate health coverage.

Medicaid rolls grow, as Medicaid picks up the slack from the unraveling system of employer-based insurance.

•      -Medicaid is particularly vulnerable as a means-tested program – its consituency is not politically powerful.
•      -Authors: "Funding for Medicaid depends on politicians' sense of decency, always a fragile foundation for policy."
•      -States fund an average 40 percent of Medicaid – unable to operate at a deficit, states are squeezed by growing Medicaid costs.
•      -Attempts to privatize Medicaid for profit – states like South Carolina are seeking federal waivers to offer recipients vouchers for purchase of private insurance – certain to be inadequate for many.

So-called ‘consumer-directed’ health plans requiring higher out-of-pocket medical expenses are not a cure.

•      -Health Savings Accounts (HSAs) serve as a tax break for the rich, but do nothing for the lower income.
•      -HSAs undermine employment-based health care, encouraging adverse selection – HSAs are attractive to healthier individuals, tempting them to opt out of company plans, leaving them less healthy individuals.

The authors cite a large body of evidence indicating that public insurance of the kind in many European countries achieves equal or better results at much lower cost.

Unfortunately, political will is lacking. Krugman and Wells call it "politically smarter" and "economically superior" to educate voters about the huge advantages of a single payer system, than to merely attempt to coopt the drug and insurance lobbies by writing them into compromise plans that they will likely oppose anyway. Alternatively, say the authors,"things will have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology."

Everything speaks to the need to grow a grassroots movement in order to overcome the powerful insurance and pharmaceutical lobbies that write policy, as they did Medicare prescription drug reform, with billions of dollars of subsidies and inflated profits to enhance their bottom lines.

The reporting in the media around candidate health care reform proposals perpetuates a false premise: the notion that health care reform revolves  around the question of whether or not to enforce a mandate to purchase private insurance. Growing numbers of under-insured will testify that insurance does not equal health care. At best, mandates move people from uninsurance to undersinsurance, leaving families at health and financial risk.

However, the insurance industry promotes mandates and taxpayer subsidies to private insurances because they enhance their bottom line, while failing to address cost and quality controls for health coverage.

Following is information forwarded from Rep. Morgan Carroll about the money spent by insurance, pharmaceutical and related lobbies. The insurance and pharmaceutical have recouped many billions of dollars in profits in return for  their lobbying investment.

From 1998 - 2007 here''s how much the following industries spent on lobbying  activities nationally:
Insurance Industry spent $1,008,474,967 on Lobbying
Pharmaceutical Industry spent $1,316,714,703 on Lobbying
Hospital / Nursing Home Industry spent $563,926,474 on Lobbying
Health Professionals spent $531,096,203 on Lobbying
*SOURCE: Open Secrets.org

Imagine how much cheaper your premiums might be if YOU weren't paying $3.95 BILLION for their lobbying activities since 1998? ($3,951,308,550 to be precise). That would have been enough to pay for an entire year of insurance premiums for 1,069,655 individuals at the average of $3,695 per year for individual coverage.
*SOURCE: Kaiser Family Foundation

The consumer is ultimately footing a big bill for lobbying activities that are not always in their best interests.

Throughout the process of the Colorado Blue Ribbon Commission for Health Care Reform, the two large Denver newspapers have consistently failed to present factual information about the Colorado Health Services Single Payer Proposal -- the one that was most favorably evaluated by the Lewin Group.

Since March of 2007 both The Denver Post and the Rocky Mountain News have each printed a number of commentaries by 'free-market' health care advocates Brian T. Schwartz and Paul Hsieh, as well as commentaries by Sen. Andy McElhany and ex-Senator Mark Hillman. Only Rep. Claire Levy was granted a commentary in the Post that dissented from the predominant 'free market' view.

At least five commentaries since the Spring of 2007 have been submitted by myself and others about the advantages of the Single Payer proposal, as well as the broken system of third-party multi-payer commercial health insurances. The information has been ignored by the Post and the News. Only out-state papers like the Pueblo Chieftain and some northern Colorado papers, including the Fort Collins Coloradoan and the Northern Colorado Business Report, have consistently printed different perspectives of health care reform, including the Single Payer perspective.

In May 2007 Todd Engdahl, a Post editorial page editor, notified me that he planned to print a commentary/overview that I had written about the Colorado Health Services Single Payer health care reform proposal then being evaluated by the Lewin Group for the 208 Commission for Health Care Reform. Subsequently, Engdahl was one of eight or so reporters and editors 'retired' by the Post. I followed up with Post assistant editorial page editor, Barbara Ellis, who repeatedly assured me the paper would print a piece about the single payer health care proposal. Each time we have sent something to the Post, Ms. Ellis has responded to the effect, "Thank you, we are considering how to present health care reform, and we will be in touch."

In January, before the 208 Commission for Health Care Reform presented their final recommendations to the legislature, a piece was sent to the Post signed by the board president and vice president of Health Care for All Colorado, critiquing the draft recommendations by the 208 Commission, based on a Massachusetts-style mandate for private insurance, and elaborating on advantages of Single Payer insurance. When I followed up with Ms. Ellis in early February, inquiring why no commentary presenting the Single Payer health care proposal has been printed in the past year, I received the following email from her:

"With the governor and his staff about to propose their own health care reform plan, publishing anything by the individual groups involved in submitting proposals to the 208 Commission is taking the story backward instead of forward."

"However, if you or anyone else should have anything to write in response to that plan once it is detailed, feel free to send it to us. I'm sure you can understand that the 208 Commission's report may be rendered moot by the governor's plan, so we're trying to take the story forward. Should the single payer plan still be part of the discussion, we'd value your input."

On February 2, 2008, the Post printed an editorial wrongly stating that, of the five reform proposals, Single Payer universal health care is the 'costliest option,' costing an 'additional $15 billion a year.'

The lack of understanding of the Single Payer proposal by the Post editorial board alone is disturbing, and it is quite understandable why Coloradans who have been so poorly served by local media totally lack understanding about what the 208 Commission has done, and what the proposals would accomplish (or not), let alone the results of the Lewin Group evaluation of the proposals.

Only one proposal evaluated by the Lewin Group, the Colorado Health Services Single Payer Plan, demonstrated the capability of providing comprehensive health coverage for all, and of reducing health care costs. Reported annual health cost savings to the state were $1.4 billion. More than $4 billion additional costs savings were reported for Colorado businesses, families, providers and hospitals. See Lewin Report Single Payer Cost Savings. The $15 billion public funding for Single Payer represents a shift from the current higher rate of private out-of-pocket health care costs (premiums, copays and deductibles, etc) that we all currently pay. In place of these high out-of-pocket private health costs, everyone would pay a progressive tax (the individual and employer tax is the source of $15 billion public funding) that for all except those making over $100,000 a year, would be less than their current out-of-pocket health care expenses.

The Rocky Mountain News exercised their own version of news blackout on the issue of health reform, early on writing an editorial titled "Single Payer Baloney" advising that Single Payer reform be dismissed as unreasonable and unworkable. 

After saying he wanted to present another perspective and repeatedly failing to do so, Rocky Business editor Rob Reuteman informed me in a phone conversation that he was "not going to confuse the readers by printing" my commentary about single payer, calling it "pie in the sky," and insisting that he could not understand where the funding would come from.

Is it any wonder that so many are still in the dark about health care reform in Colorado? We still have not had a honest and open exchange of information surrounding health care reform – when are we going to hear the broader perspective? If the local news media refuse to provide a forum, then who will? It is no wonder that the multi-billion-dollar insurance and pharmaceutical industries continue to write health care policy, as they did with Medicare prescription drug reform, granting themselves billions of dollars of taxpayer subsidies and inflated profits to enhance their bottom lines. Simultaneously, commercial insurances game the system to increase their profits by delaying, denying and reneging on claims they should be covering.

One can only assume that the corporations that own the media set the standards of news coverage – selectively influencing what information is and is not made available to readers.

The Colorado Blue Ribbon Commission for Health Care Reform based its recommendations to the legislature on its own 5th Proposal, modeled after Massachusetts reform, with a mandate to purchase private insurance, no controls of insurance costs, and taxpayer subsidies to private insurances.

A cornerstone of the Massachusetts plan as adopted by the 208 Commission is an individual mandate that compels everyone to purchase private health insurance, or suffer tax penalties.

Comprehensive health plans in Massachusetts total $6,000 annually for an individual or $14,000 for a family - prohibitive costs for many. 'Affordable' coverage is often a bare-bones, stripped-down 'minimum benefit' insurance averaging $660/month for a family, and $330 for an individual - still unaffordable to many working families. Stripped-down policies, with high copays and deductibles, do not provide adequate protection against serious health or financial risk.

A 2005 Harvard Medical and Law Schools study estimated that 76 percent of those bankrupted by medical bills had insurance at the onset of the illness that bankrupted them. As noted previously, high-deductible or catastrophic insurances have contributed to a 59 percent rise in consumer out-of-pocket health expenses and a 60 percent rise in uncompensated hospital care over a decade (reported by the American Hospital Association).

The Massachusetts plan does nothing to control insurance costs or eliminate the high overhead costs, including exorbitant CEO salaries and profits, of multi-payer insurances. Therefore, Massachusetts continues to experience annual double-digit premium increases, shifting more people into taxpayer-subsidized private insurances or public programs. It is a recipe for the downward spiral that renders more people under- and uninsured, and shifts increasing costs to taxpayers.

Read 2-3-08 Denver Post article about the Massachusetts mandate - the Massachusetts 'Health Care for All' mentioned in the story co-authored Massachusetts reform, and is actually a group funded by commercial insurance companies.