.  .  .

National health care spending is climbing by more than 7% per year, outpacing economic growth by a substantial margin. As health care costs have climbed, so has the number of people without health insurance in the United States, even during a period of overall economic growth. In 2004, according to U.S. Census data, nearly 46 million people of all ages were uninsured, an increase of 6 million over 2000. This combination of eroding health insurance coverage and rapidly rising health care costs raises concerns about the ability of U.S. families to obtain timely medical care, protect their finances from catastrophic health care costs, and save for retirement.

.  .  .

Rising Numbers of Uninsured Individuals Are in Moderate and Middle-Income American Families

Two of five (41%) working-age Americans with incomes between $20,000 and $40,000 a year were uninsured for at least part of the past year—a dramatic and rapid increase from 2001 when just over one-quarter (28%) of those with moderate incomes were uninsured.

Adults with incomes under $20,000 were still the most likely to be uninsured: more than half (53%) had spent time uninsured in the past year.

Most people who are uninsured are in working families. Of the estimated 48 million American adults who had any time uninsured in the past year, 67% were in families where at least one person was working full time.

Many Americans Report Medical Bill Problems and Medical Debt

One-fifth (21%) of working-age adults, both insured and uninsured, currently have medical debt they are paying off over time and more than two of five (44%) of these individuals are carrying $2,000 or more in debt.

More than one-third (34%) of adults ages 19 to 64 either had medical bill problems in the past year or were paying off accrued medical debt. Problems include not being able to pay bills, being contacted by a collection agency about unpaid medical bills or having to change their way of life to pay bills.

Three of five (62%) of all adults with medical bills or debt problems said they or their family member were insured at the time the debt was incurred.

More than half (51%) of uninsured adults reported medical debt or bill problems. Of those, nearly half (49%) used up all their savings to pay their bills. Two of five were unable to pay for basic necessities like food, heat or rent because of medical bills.

Rates of medical bill problems and debt were high among people in both lower-income and higher-income households who experienced a time uninsured. Indeed, rates were highest among those with higher incomes. Nearly three of five (59%) adults with incomes of $40,000 or more reported difficulties with medical bills or accrued debt. Forty-six % of adults with higher incomes were paying off unpaid medical bills over time, with over half (54%) of these individuals carrying $2,000 or more in medical debt.

People With Gaps in Coverage Have Difficulty Managing Chronic Conditions
An alarmingly high proportion—59 %—of uninsured adults who had a chronic illness, such as diabetes or asthma, did not fill a prescription or skipped their medications because they could not afford them.

More than one-third (35%) of uninsured adults who had a chronic condition went to an emergency room or stayed overnight in the hospital in the past year because of their condition—about two times the rate of people with chronic health problems who were insured all year.

Individuals With Gaps in Coverage Are Much Less Likely to Get Preventive Care

Only 18 % of uninsured adults ages 50 to 64 had a colon cancer screen in the past five years, compared with 56% of adults insured all year.

Less than half (48%) of uninsured women ages 50 to 64 had a mammogram in the past two years, compared with 75% of women who were insured all year.

Few adults without medical insurance receive dental care: only 35% of those uninsured at the time of the survey had a dental exam in the past year, half the rate of those who were insured for the full year.

People With Gaps in Coverage Experience Inefficient Care

Nearly one-quarter (23%) of adults who reported spending any time uninsured in the past year said test results or medical records were not available at the time of a scheduled appointment, compared with 15% of continuously insured adults.

Nearly one of five (19%) adults with any time uninsured said he or she had been given a duplicate test, twice the rate of duplication reported by continuously insured adults.

S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, and A. L. Holmgren, Gaps in Health Insurance: An All-American Problem, The Commonwealth Fund, April 2006

Gaps in Health Insurance: An All-American Problem, April 2006 http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Apr/Gaps-in-Health-Insurance–An-All-American-Problem.aspx

Over a quarter of the uninsured are middle class Americans.

Nearly one in four middle class employees are not offered health insurance by their employers – and of those that are not, more than half remain uninsured. In comparison, only one in six high-income employees are not offered health insurance by their employers.

Part of the reason that middle income Americans are less likely to be offered coverage is because they are more likely to work in small businesses – 53% of middle income Americans work in small businesses, compared with 46% of higher income Americans. Of those who work in small business, 40% are not offered insurance.

11% of middle class adults reported delaying needed care and 8% reported avoiding care altogether because of high cost in 2007.

Middle class adults are also more likely to avoid care because of rising costs compared to higher-income adults, where only 5% reported delaying and 3% reported avoiding needed care.

The problem is particularly worse for those middle class adults who are uninsured, where more than one in five delayed or avoided needed care because of cost in 2007.

Regular visits to the pediatrician are important for healthy child development, and yet too many middle class children do not see a physician regularly. 12% of middle class children did not have a health care visit in the past year, compared to 8% of high-income children.

Task Force Report on Uninsured and Underinsured in Middle Class (Sept 2009)

“We’re losing more Americans every day because of inaction than drunk driving and homicide combined,” Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

.  .  .

Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.

(Editing by Xavier Briand)  WASHINGTON (Reuters)
Source: http://www.reuters.com/article/healthNews/idUSTRE58G6W520090917

By DANIEL P. WIRT, MD

The data and evidence are clear: to a scientific certainty, only a single-payer “Medicare-for-All” system of health care financing will solve the serious cost and access problems and achieve good, affordable health care for all in the United States. As a scientist and physician, this is my conclusion after studying the data for years. The data are voluminous, stretching back to World War II, and come not only from the United States, but from all other industrialized countries. Except for the United States, all industrialized countries have some form of universal health care.

Americans are increasingly afraid that they can’t afford to get sick, and with good reason. About half of all personal bankruptcies are caused by medical expenses, and 76% of these individuals had health insurance when they got sick or injured. Those of us with insurance are paying a greater share of the premium and more deductibles and co-pays as well. Thus, not only do we have 46 million Americans without health insurance, but at least an equal number who are seriously underinsured. With the recent economic downturn, the ranks of those who are uninsured and underinsured are growing. Many are faced with choosing between paying for medicine and needed health care and paying for food and housing. A typical story is: get sick or injured, lose your job, lose your health insurance, go bankrupt.

A majority of physicians (59%) and an even higher proportion of Americans (at least 62%) support single payer national health insurance or “Medicare-for-All”. In spite of this, virtually all we are hearing about today are mandate plans that would require everyone to buy the same private for-profit insurance that is already failing us. The for-profit insurance companies and their plethora of plans make for a terribly complex, fragmented, costly and inefficient system. Administrative overhead consumes about 31% of health care dollars in the United States, and the for-profit insurance companies are responsible for half of this, or 15% of $2.4 trillion. This money, more than $350 billion per year, provides no health care: it is consumed by enormous administrative costs, profits for investors and shareholders, and large salaries for managers of these for-profit insurance companies.

All of the incremental reform programs proposed — tax subsidies, health savings accounts, individual or employer mandates, increased regulation of for-profit insurance companies — keep these proverbial foxes in the henhouse and are doomed to fail to control costs and provide universal access. Competition among the foxes does not benefit the chickens, the patients, the doctors or the hospitals. The for-profit insurance companies fundamentally reduce choice — your preferred doctor or hospital is “out-of-network?” Too bad, we won’t pay, says your insurance company.

The data are in. Incremental reforms, mostly mandate schemes which retain the for-profit insurance companies, have been tried in seven states over the past two decades: Massachusetts, Tennessee, Washington, Oregon, Minnesota, Vermont, Maine. In all of these states the reforms have failed to contain costs. In all but Massachusetts, they have failed to reduce the number of uninsured. In Massachusetts, there has been a modest decrease in the number of uninsured, falling from 13% of adults in 2006 to 7.1% of adults in 2007, but at the cost of a substantial increase in public spending (spending for “Commonwealth Care” was $629.8 million in fiscal year 2007, $1089.2 million in fiscal year 2008 and $1317.7 million in fiscal year 2009). Most of the gain in Massachusetts has come from expanding Medicaid and subsidizing the purchase of private insurance; very few people have signed up for the unsubsidized but mandated private insurance. Not to mention that 7.1% uninsured is unacceptably high. Far from controlling costs, these mandate plans will add hundreds of billions of dollars to the nation’s health care costs.

The United States spends about twice as much per capita on health care than other industrialized countries. Yet it is a myth that the United States has the best health care in the world. The United States ranks near the bottom of industrialized countries in terms of important morbidity and mortality outcomes (for example, life expectancy and infant and maternal mortality). Out of 19 industrialized countries, the United States ranks last in reducing deaths from treatable conditions (Health Affairs, 2008). About 18,000 American adults die unnecessarily every year due to lack of insurance (Institute of Medicine, 2002). As reported in the Archives of Internal Medicine in 2003, repair of an aortic aneurysm cost $8,647 in Canada and $13,432 in the U.S. What accounted for the substantial difference? Most of the difference was due to much greater overhead costs in the U.S. The surgeons and surgical facilities are top-notch in Canada. The surgeons are very well-paid. The difference is that Canada has adopted a true insurance system for financing health care, one that spreads risk across a broad population: a publicly funded single-payer national health insurance plan that eliminates the parasitic, investor-owned “insurance” companies that make profits by enrolling the healthy, screening out the sick and denying claims.

Single-payer national health insurance for financing health care is NOT “socialized medicine.” Under a single-payer, “Medicare-for-All” system, delivery of health care remains private. The providers of health care remain private. Patients choose any doctor and any hospital. Parenthetically, replacing the wasteful for-profit insurance companies with a single-payer national health insurance program for financing health care in the United States would save enough money (more than $350 billion) to not only achieve universal coverage, but allow the coverage to expand and be more comprehensive, while not spending any more than we do now.

We have an American system that works. It’s Medicare. It’s not perfect, but Americans with Medicare are far happier than those with for-profit insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down. And keep in mind that Medicare insures people with the greatest health care needs: people over 65 and the disabled. We should improve and expand Medicare to cover everyone. In contrast to the wasteful for-profit insurance companies, Medicare has a very low overhead — about 3%. Unfortunately, the for-profit insurance companies have been infiltrating Medicare in the form of “Medicare Advantage” plans, substantially raising costs when compared to traditional Medicare.

A single-payer “Medicare-for-All” system — improved and expanded Medicare — is embodied in a bill currently in the U.S. House of Representatives, H.R. 676, sponsored by Rep. John Conyers, D-Mich., and cosponsored by 93 other members of Congress in the last congressional session. Its features are: automatic enrollment for everyone; comprehensive services covering all medically necessary care and drugs; free choice of doctor and hospital, who remain independent and negotiate their fees and budgets with a public or nonprofit agency; processing and payment of bills by a public or nonprofit agency; promotion of job growth and the entire U.S. economy by removing the excessive burden of health care costs from businesses; coverage for everyone without spending any more than we are now.

The growth in health care costs must be addressed if any proposal is to succeed. Single-payer offers real tools to contain costs: budgeting, especially for hospitals, planning of capital investments (to avoid wasteful duplication and concentration of expensive technology), and an emphasis on primary care and coordination of care. Mandate plans offer only false hopes: competition among for-profit insurance companies, computerization and chronic disease management. Competition among the shrinking number of for-profit insurance companies has already failed to contain costs and, in the absence of single-payer and reformed primary care (so that everyone has a primary care home), computerization and chronic disease management will raise costs, not lower them.

Single-payer “Medicare-for-All” for financing health care is the right answer. It is right on choice: it provides free choice of doctor and hospital, the choice Americans want and value. In mandate plans, we lose those choices. It is right on efficiency and quality: single payer would slash administrative costs and promote efficient primary care. It would also enhance evidence-based quality assurance. It is right on accountability: it will be a public, nonprofit system that will respond to what doctors and their patients need, not what corporate executives and their stockholders want. The nation will pay about the same, while covering all Americans (no more exclusions based on “pre-existing conditions”). A modest increase in employer/employee payroll taxes would be offset by savings in out-of-pocket costs for insurance premiums, deductibles and co-payments, as well as by more comprehensive health services coverage.

The single-payer program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. No co-pays or deductibles are allowed. The program will negotiate reimbursement rates annually with physicians, allow for global budgets for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment.

Business leaders are well on their way to understanding how the current system makes their businesses uncompetitive with those in industrialized countries that have cost-effective health care systems not based on profit. Doctors and hospitals are increasingly fed up with the current system. Increasingly, both realize that treating health care as a commodity that some can afford and others cannot — apportioned based on profit motive and the ability to pay, rather than need — is the most irrational and inhumane form of rationing and interferes with their mission of providing high-quality, compassionate, evidence-based, necessary health care to patients, while still maintaining adequate operating budgets, capital budgets and incomes for health care providers and administrators.

Finally, the most important group is patients. We are all sometimes patients. All patients must rise up and remove the foxes from the henhouse. Foxes are not evil, but their nature is such that they must not be allowed in the henhouse.

(Originally published on CounterPunch)

Daniel P. Wirt, M.D. is a Pathologist, Houston, Texas and member of Health Care for All Texas and member of Physicians for a National Health Program.

Suppose that people in the United States paid twice as much for our cars as people in Canada, Germany, and every other wealthy country. Economists would no doubt be pointing out the enormous amount of waste in the US auto industry. They would insist that we both take advantage of the lower cost cars available elsewhere and take steps to make our own industry more efficient.

For some reason, economists do not have the same attitude towards health care. Most seem little bothered by the fact that we spend more than twice as much per person as people in other countries, with no obvious benefit in terms of health care outcomes. This lack of concern is especially striking since health care is a far larger share of the US economy than autos, comprising 17 percent of total output, as compared to about 3% for autos.

The excess health care spending comes to more than $1.2 trillion a year or the equivalent of more than $16,000 for a family of four. Paying too much for health care has the same economic impact as a health care tax. In effect, we have a health care waste tax that is about 10 percent larger than the projected federal revenue from the personal and corporate income tax combined. In short, this is real money.

By Dean Baker, co-director of the Center for Economic and Policy Research AlterNet
Posted on May 19, 2009, Printed on October 1, 2009 © 2009 Independent Media Institute. All rights reserved. http://www.alternet.org/story/140098/

The Health and Human Services Department launched its investigation of Humana after getting a complaint from Sen. Max Baucus, D-Mont., a senior lawmaker usually viewed as a reliable ally of the insurance industry.

.  .  .

Humana Inc., headquartered in Louisville, Ky., is cooperating with the investigation and stopped the mailer earlier this month, company spokesman Tom Noland said Monday.

The Senate committee that Baucus chairs — Finance — will vote this week on a sweeping health care plan that he’s proposed to expand coverage and try to control costs. It would cut Medicare and Medicaid spending by about $500 billion over 10 years, but Baucus says that would lead to greater efficiency, not reduced benefits.

“The health care reform bill we released … strengthens Medicare and does not cut benefits,” said Baucus. “From lower prescription drug costs, to free preventive care, to better treatment for chronic conditions, seniors have so much to gain from health reform — and I’m not going to let insurance company profits stand in the way of improving Medicare for seniors.”

Humana is one of the largest private carriers serving . . . 1.4 million Medicare Advantage enrollees, and the program accounts for about half the company’s revenue, Noland said.

Government experts say the private plans are being paid too much — about 14% more than it costs to care for seniors in traditional Medicare. The Baucus plan — and other proposals — would reduce payments to the plans, and the health insurance industry is fighting back.

The Humana mailer focused squarely on the Medicare Advantage program.

“While these programs need to be made more efficient, if the proposed funding cut levels become law, millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable,” it said. (More)

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer Mon Sep 21, 3:19 pm ET

.  .  .

Associated Press writer Bruce Schreiner in Louisville, Ky., contributed to this report. Reports from Kathleen Sebelius’ Health and Human Services outline how Medicare would be stronger after reforms. http://www.wibw.com/political/headlines/61299032.html

.  .  .

David Donnelly, the Fund’s national campaigns director, noted on the group’s website that the health insurance companies and HMOs are spending nearly $700,000 daily against health care reform efforts. “Why are so many in Congress willing to listen to an industry that is spending tens of millions every month on politics,” asked Donnelly, “rather than lowering their premiums or helping to address the costs of health care?”

Another nonpartisan, nonprofit watchdog that is tracking money in American politics is the Center for Responsive Politics, which notes that health insurance interests have 875 registered lobbyists working for them and HMOs have 920. The Center provides a lobbying database on their website where individuals can search for the total spending by a particular industry (e.g., health insurance, pharmaceutical), view the interests that lobbied a specific government agency, and other information.

.  .  .

Health Insurance Companies Spend Millions to Fight Health Reform Submitted by Deborah Mitchell on Sep 16th, 2009 http://www.emaxhealth.com/1275/72/33579/health-insurance-companies-spend-millions-fight-health-reform.html http://www.emaxhealth.com/1275/72/33579/health-insurance-companies-spend-millions-fight-health-reform.html

Essentially, a public option in a health insurance reform bill would provide American citizens with the choice of having a private health insurance plan or the plan currently available to members of Congress and other federal officials. It would drive down premiums while allowing citizens struggling to find or afford health insurance a viable health care option.

Public support for a public option has been consistently high over the past year. An August poll by SurveyUSA shows 77% of Americans support their right to choose a public health insurance option.

Yet over the past several weeks, we’ve seen everyone from senators Mitch McConnell, R-Ky., and Olympia Snowe, R-Maine, to Max Baucus, D-Mont., chairman of the Senate finance committee, run away from a public option. We’ve seen members of the conservative Democrat Blue Dog Coalition in the House of Representatives demand its exclusion from a health reform bill. We’ve seen conservative commentators like Rush Limbaugh, Glenn Beck and Sean Hannity assault proponents of a public option as socialists hell-bent on wrecking the private health care industry.

The truth is proponents of the public option understand the inexplicably high costs, both financial and moral, of maintaining the status quo into the future. The United States pays staggeringly more of its GDP on health care than any other nation on earth. Costs are projected to rise to unforeseen heights as baby boomers reach their 70s and the next generation approaches retirement. Frank Clemente, in a February report by the Institute for America’s Future, argues “the savings that can be achieved by insuring millions of people in a public health insurance plan may be enough to pay for covering the 46 million Americans currently without insurance.”  . . .

What is being done is leaders (and I use that term loosely) playing campaign politics with a moral and fiscal issue of grand proportions. If we don’t include a public health insurance option in the upcoming health care reform package, we’ll be left with unfunded mandates and no mechanism to bring down long-term costs.

Without the public option, we’ll face continued health care failure. Our future economic and health security just can’t afford that.

By Ian Sams – Junior at University of Alabama, “We Need a Public Option” The Crimson White, Friday, September 25, 2009- http://www.cw.ua.edu/we-need-a-public-option-1.1914276

Since 1987, we’ve advocated for reform in the U.S. health care system. We educate physicians and other health professionals about the benefits of a single-payer system–including fewer administrative costs and affording health insurance for the 46 million Americans who have none.

Our members and physician activists work toward a single-payer national health program in their communities. PNHP performs ground breaking research on the health crisis and the need for fundamental reform, coordinates speakers and forums, participates in town hall meetings and debates, contributes scholarly articles to peer-reviewed medical journals, and appears regularly on national television and news programs advocating for a single-payer system.
PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program.

Physicians for a National Health Program (PNHP) believes that access to high-quality health care is a right of all people and should be provided equitably as a public service rather than bought and sold as a commodity.

The mission of PNHP is therefore to educate physicians, other health workers, and the general public on the need for a comprehensive, high-quality, publicly-funded health care program, equitably-accessible to all residents of the United States.

Equitable accessibility requires, in the view of PNHP, removal of the barriers to adequate health care currently faced by the uninsured, the poor, minority populations and immigrants, both documented and undocumented.

PNHP views this campaign as part of the campaign for social justice in the United States. PNHP opposes for-profit control, and especially corporate control, of the health system and favors democratic control, public administration, and single-payer financing.

PNHP believes this program should be financed by truly progressive taxation. PNHP actively opposes current changes in the health care system that are designed to maximize the profits of investors and the incomes of high-level executives rather than to serve patients.
PNHP’s goal is the restoration of what it views as the primary mission of physicians, acting as professional advocates for our patients.

PNHP is an independent, non-partisan, voluntary organization. PNHP’s work is supported by our members’ dues and contributions, and by grants from progressive foundations; it accepts no funding from pharmaceutical companies or other for-profit entities. PNHP organizes physicians, medical students, other health workers, and the public in support of this program and promotes discussion of health policy in the U.S. through conferences, lectures, articles, and other methods.

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Imagine a global economy offering fair opportunities to everyone and hope of a better future for all of our children. Efforts to attain that dream will do more to stop terrorism and avoid war than would any homeland security system or deadly weapon.