Prometheus 6

What’s Happened to the Health Care Debate?
By Ezekiel Emanuel

The presidential campaign is a little more than three weeks old and the indications are that health care has fallen off the radar screen. One measure is each candidates’ acceptance speech at the convention. The speeches give a clear indication of their priorities and their sense of where they think the campaign and country are focused.

While family members refused to look at Haige's insurance plan as a death sentence, it soon became clear that their loved one was facing the biggest fight of his life.

Man Succumbs To 7-Year Battle With Health Insurance
September 22, 2008 | Issue 44•39

DENVER—After years of battling crippling premiums and agonizing deductibles, local resident Michael Haige finally succumbed this week to the health insurance policy that had ravaged his adult life.

Haige, who had suffered from limited medical coverage for nearly a decade, passed away early Monday morning. According to sources, the 46-year-old was laid to rest at Fairplains cemetery, surrounded by friends, family members, and more than $300,000 of mounting debt.

McCain Health-Care Article Fuels New Clash Over Economy
By Dan Balz
Washington Post Staff Writer
Sunday, September 21, 2008; A07

JACKSONVILLE, Fla., Sept. 20 -- An article about health care published in an obscure journal led to a new skirmish Saturday between the campaigns of Democrat Barack Obama and Republican John McCain over who should be trusted with the ailing economy.

The article included a favorable reference to banking deregulation that, in light of this week's near-meltdown in the financial industry, provided an irresistible target for Sen. Obama's campaign and once again put Sen. McCain on the defensive. McCain's campaign accused Obama of manufacturing an attack by deliberately misreading the Republican's words.

So I'm on this mailing list that's basically about monitizing "new media" intellectual property. I basically lurk, even through the rare socio-political discussions. I'm too concerned about potential a police state to usefully discuss how to make the best of it.

Anyway, a discussion kicks off about "Joe Biden's Tech/Music IP Record" which frankly was not going that well for Joe at first but the thread fractured all to hell, and I sorta poked it at random and hit a post made in response to this statement

All the places I know where everyone gets the same health care has poor health care. Just got back from UK where people are dying every day simply they don't approve the expensive cancer drugs because they're well, expensive. It is a very big issue over there - at least from what I read.

I wanted to share the response with you because it makes several points best made by a witness. That the uninsured are charged more for drugs than the insured amazes me. This man is what you call affluent, fully insured and is still spending $20k for his wife's treatment this year.

His name is redacted, but this is an actual human being speaking, no spin or speculation.

This time the agreement is pretty absolute. Bits 'o emphasis added here and there...

...why be nervous about the prospects for reform? Because it’s hard to get universal care established in the first place. There are, I’d argue, three big hurdles.

First, the Democrats have to win the election — and win it by enough to face down Republicans, who are still, 42 years after Medicare went into operation, denouncing “socialized medicine.”

Second, they have to overcome the public’s fear of change.

Some health care reformers wanted the Democrats to endorse a single-payer, Medicare-type system for all. On the sheer economic merits, they’re right: single-payer would be more efficient than a system that preserves a role for private insurance companies.

It enabled the subprime mortgage bubble and collapse. I'm sure it will be at least as helpful for the medical insurance companies.

Also, if I recall correctly, there's health information on your credit report...yup, check the bolded line from this, on employment background checks:

Aren't some of my personal records confidential?

The following types of information may be useful for an employer to make a hiring decision. However, under the federal Fair Credit Reporting Act, the employer is required to get your permission before obtaining the records. (See PRC Fact Sheet 11, "From Cradle to Grave: Government Records and Your Privacy," www.privacyrights.org/fs/fs11-pub.htm)

--------------->8---snip-snip!!---8<---------------

• Medical records. In California and many states, medical records are confidential. There are only a few instances when a medical record can be released without your knowledge or authorization. The FCRA also requires your specific permission for the release of medical records. If employers require physical examinations after they make a job offer, they will have access to the results. The Americans with Disabilities Act allows a potential employer to inquire only about your ability to perform specific job functions. (42 USC §12101)

The FCRA is the Fair Credit Reporting Act, and I don't think the FCRA compels credit agencies to show YOU that information at all...after all, it's not credit information.

Oh, right...this is what brought all that on...

Prescription Data Used To Assess Consumers
Records Aid Insurers but Prompt Privacy Concerns
By Ellen Nakashima
Washington Post Staff Writer
Monday, August 4, 2008; A01

Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health "credit report" drawn from databases containing prescription drug records on more than 200 million Americans.

Collecting and analyzing personal health information in commercial databases is a fledgling industry, but one poised to take off as the nation enters the age of electronic medical records. While lawmakers debate how best to oversee the shift to computerized records, some insurers have already begun testing systems that tap into not only prescription drug information, but also data about patients held by clinical and pathological laboratories.

Single payer health care. Call it socialism if you like.

Paying Doctors to Ignore Patients
By PETER B. BACH

THE longstanding push-pull between Medicare and Congress has erupted again. Last week, Congress, overriding a presidential veto, canceled Medicare’s scheduled 10.6 percent cut in payment rates for doctors, and instead raised the rates 1.1 percent. But this action fails to address the problem with the Medicare payment system, which is not the amounts doctors are paid but the way their payments are calculated.

Medicare pays doctors for specific services. If a patient has a checkup that includes an X-ray, a urine analysis and a physical, Medicare pays the doctor three separate fees.

Two things turned that around. The American Medical Association used a vigorous advertising campaign against Republican senators who were blocking a vote on the bill, cowing them into retreat. And the ailing Senator Edward Kennedy made a dramatic appearance on the Senate floor to guarantee a Democratic victory, at which point Republicans started switching sides. ...The House overrode the president’s veto by a thumping 383 to 41, with 153 Republicans defying the president. The Senate vote was a convincing 70 to 26, with 21 Republicans abandoning the White House.

Welcome Rout on Medicare

The surprising thing about the intense Congressional struggle over a modest bill to improve Medicare was how quickly it turned from a cliffhanger into a rout. President Bush’s veto was easily overridden as Republicans in droves abandoned his misguided effort to help the insurance industry hold on to its large subsidies.

We hope this means that the next Congress will be emboldened to make more far-reaching reforms in Medicare to help keep the system solvent and able to provide high-quality care for older Americans.

But I was not prepared for this question. I told the surgeon I would call back with the insurance information, which forced me to call the transferring doctor. I can't remember if the child was underinsured, uninsured or was insured by the state, but it didn't matter. When I called the surgeon back, he refused to come in. His group didn't cover "those kinds" of patients.

Such is our peculiar institution called American healthcare. We have gobs of money, the best technology, plenty of specialists, and spend the most money on healthcare in the world. Despite that, a child gets left out in the cold.

When the bottom line overrides the Hippocratic Oath
As a naive pediatric resident, I couldn't believe it when the surgeon called back and said we don't treat those kinds of patients.
By Rahul K. Parikh, M.D.

Jul. 16, 2008 | I don't remember many specific patients from my days as a resident. Like all doctors in training, I was overworked, underpaid and chronically fatigued. With that, details become murky.

What I do remember, though, are certain incidents that gave me pause and made me wonder what the hell I had gotten myself into. The kinds of situations that only residents -- who are the blunt business end of America's sloppy healthcare system -- can get stuck in.

Medicare now pays the private plans, on average, 13 percent more than the same services would cost through traditional Medicare. The subsidies have fueled explosive growth in the least-efficient plans, fee-for-service plans, which do little or nothing to justify their 17 percent overpayment.

This is outrageous. Instead of paying private plans less than traditional Medicare, in the belief that they could find innovative ways to cut costs and improve care, we are now paying them significantly more. The only explanation is Republicans’ ideological compulsion to provide a private option.

Medicare’s Bias

The intense struggle in Congress last week over a relatively modest Medicare reform bill has underscored a disturbing truth: many of the private plans that participate in the huge government-sponsored health insurance program for older Americans have become a far too costly drain on Medicare’s overstretched budget.

Private health plans were promoted in the 1980s and 1990s in the belief that they could reduce costs and improve care through better management. And for a while they did. But policy changes that were championed by the Bush administration and a Republican-controlled Congress led to exactly the opposite outcome.

Seeing how things aren't always turning out the way we'd expect, I'd like you to read Columbia Journalism Review's Memo To Health Care Reporters and the Catholic Courier's Confronting the cost of health care in connection with this article.

Democrats Gear Up New Push for Universal Health Care
By Perry Bacon Jr.

Democrats are launching an aggressive push for universal health care, fourteen years after a failed attempt on the issue resulted in political disaster.

A coalition of liberal groups that includes major labor unions such as the Service Employees International Union and the activist group MoveOn.org announced today it will spend $40 million to make health insurance a major issue in the campaign, with Elizabeth Edwards, the wife of former Democratic presidential candidate John Edwards, as the one of the group's main spokespersons. The group, which has dubbed itself "Health Care for America Now!" plans to spend its money running ads in battleground states, canvassing 45 states to get people to sign petitions supporting the initiative and trying to get every member of Congress to sign a pledge to expand health insurance to all Americans.

Meanwhile, on Capitol Hill, Democratic staffers are trying to set up a structure for getting a bill through Congress next year.

“I’d like to get it, but what do you pay first?” Mr. Benamor asked at his dining room table. “Do you pay the mortgage? Do you pay your child support? Do you pay your car insurance? Do you pay for your medicine?”

McCain Plan to Aid States on Health Could Be Costly
By KEVIN SACK

PIKESVILLE, Md. — If Senator John McCain’s radical plan for remaking American health care is to work, he will have to find a way to cover people like Chaim Benamor, 52, a self-employed renovator in this Baltimore suburb. Mr. Benamor never found it necessary to buy insurance before having a mild heart attack last year and now, 13 years shy of Medicare, has little hope of doing so.

The heart attack left Mr. Benamor with a $17,000 hospital bill, $400 in monthly prescription costs and a desperate need for insurance. After being rejected by a number of commercial carriers, he turned to the Maryland Health Insurance Plan, one of 35 state programs for high-risk applicants whom no private company is willing to insure.

ABC News' Teddy Davis, John Santucci and Gregory Wallace Report: No policy proposal more sharply divided Barack Obama from Hillary Clinton than the former first lady's plan requiring adults to purchase health insurance.

But as the one-time rivals head to Unity, N.H., on Friday, a health adviser to the presumptive Democratic nominee is signaling that Obama's plan could eventually go in Clinton's direction.

The funny thing is, this is true...yet the differences were so small you could actually ignore them for purposes of projecting the outcome of implementing each.

Please, ABC, Tell Us What This Story Is About
Another Obama flip-flop? Or just a plan that insurers will support?
By Trudy Lieberman Tue 1 Jul 2008 01:59 PM

A Dart to ABCNews.com for a muddled mess of a story that may be interesting to Beltway health cognoscenti, but is confusing as the devil to the man (or woman) on the street. The story, entitled “Obama Health Plan Could Go In Clinton’s Direction,” seems to say that Barack Obama now supports an individual mandate for health care. During the primaries, Obama repeatedly said that he would not require people (except children) to have insurance, and blasted Clinton for supporting an individual mandate.

That title may be the clearest, most sensible thing ever to appear in the NY Times Opinions section. Let me repeat it:

There is never a good reason for Medicare to pay far more than the market rate for medical equipment.

Of course, it does...and steps are being taken to make sure it continues to do so.

There is little doubt that Medicare has been paying far too much for equipment — including wheelchairs, hospital beds, oxygen concentrators, diabetic test kits, and walkers — under fee schedules based on historical charges. According to federal officials, Medicare currently pays $1,825 for a hospital bed that can be bought online for $754, and $4,023 for a power wheelchair that can be bought online for $2,174.

Even the Insured Feel the Strain of Health Costs
By REED ABELSON and MILT FREUDENHEIM

The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.

“It just keeps eating into people’s income,” said James Corbin, a former union official who works for the local utility in Tucson.

McCain Offers Market-Based Health Plan
By Michael D. Shear
Washington Post Staff Writer
Wednesday, April 30, 2008; A01

TAMPA, April 29 -- Sen. John McCain on Tuesday rejected calls by his Democratic opponents for universal health coverage, instead offering a market-based solution with an approach similar to a proposal put forth by President Bush last year.

McCain's belief in the power of the free market to meet the nation's health-care needs sets up a stark choice for voters this fall in terms of the care they could receive, the role the government would play and the importance they place on the issue.

I ask because you are the primary source of intellectual support for this damaging kerfuffle.

The truth is that the overall costs of the two plans, their essential structure, and their overarching logic are all but identical. Neither would force people to give up employment-based plans they’re happy with. Both would give people without coverage from their employer a menu of different plans, including a predictable, simple and attractive public plan modeled after Medicare. And both could cover all or virtually all Americans for a relatively modest cost. (Lest there be doubt about this, the Lewin Group, a health consulting company, recently determined that a proposal I’ve developed that is quite similar to the candidates’ plans would cost the federal government just $50 billion to cover everyone, and save our health system serious money over time.)

But unfortunately, the fierce debate has pushed both candidates toward rigid positions and extreme pronouncements, elevating a modest disagreement into a confusing melee. In the process, one of the least inherently attractive issues (for example, should people be required to obtain coverage?) has obscured more important ones (how do we ensure that people are signed up for coverage that’s affordable?). Meanwhile, John McCain (whose limited proposal to give broader tax breaks for private health insurance was the topic of my last post) has gotten a free ride.

Are You Confused Yet?
By Jacob S. Hacker

Jacob S. Hacker is a professor of political science at Yale.

Polls show that health care ranks near the top of voters’ concerns, especially among Democrats. And for those who say “the economy” is the top issue, health care is usually a major part of their financial worries.

And yet, voters must be awfully confused about where the Democrats stand on health care. On the one hand, both Barack Obama and Hillary Clinton say they want to insure everyone — and in much the same way. On the other hand, they are beating each other up at every turn. Before the Pennsylvania primary, Mr. Obama ran yet another ad arguing that Mrs. Clinton’s plan would force people to buy insurance even if they couldn’t afford it. Meanwhile, Mrs. Clinton fired back with her familiar accusation that Mr. Obama’s plan would fall well short of universality.

So what’s the main story: (1) a basic Democratic consensus about what should be done, or (2) a widening policy divide fueled by presidential ambitions? The answer is (1), but unfortunately, the reality of (2) is increasingly upstaging this welcome development. And, unfortunately, this unnecessary and self-defeating conflict could ultimately derail efforts at reform, confusing and turning off the very voters Democrats need to woo.

Co-Payments Soar for Drugs With High Prices
By GINA KOLATA

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

Mr. Krugman is getting sneaky, hiding his Hillary support behind Mrs. Edwards.

[T]here’s no reason to believe in these alleged cost reductions. Insurance companies do try to hold down “medical losses” — the industry’s term for what happens when an insurer actually ends up having to honor its promises by paying a client’s medical bills. But they don’t do this by promoting cost-effective medical care.

Instead, they hold down costs by only covering healthy people, screening out those who need coverage the most — which was exactly the point Mrs. Edwards was making. They also deny as many claims as possible, forcing doctors and hospitals to spend large sums fighting to get paid. 

Voodoo Health Economics
By PAUL KRUGMAN

Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain’s health care plan.

It’s about time someone said that and, more generally, made the case that Mr. McCain’s approach to health care is based on voodoo economics — not the supply-side voodoo that claims that cutting taxes increases revenues (though Mr. McCain says that, too), but the equally foolish claim, refuted by all available evidence, that the magic of the marketplace can produce cheap health care for everyone.

As Mrs. Edwards pointed out, the McCain health plan would do nothing to prevent insurance companies from denying coverage to those, like her and Mr. McCain, who have pre-existing medical conditions.

Maybe it didn't come on in your locality yet. Or maybe it will get multiple plays, like in New York City...we have WNET and WLIW, and WNET at least is presenting each segment like three times.

If you are serious about health care and health issues you need to see this series. Go to the PBS web site and find out when it plays in your area. Set up an email reminder so you don't miss it.

Tell me this isn't the most depressing headline of the day. 

Drawing Lots for Health Care
By WILLIAM YARDLEY

BEND, Ore. — Last month, right after he had the heart attack and then the heart surgery and then started receiving the medical bills that so far have topped $200,000, Melvin Tsosies joined the 91,000 other residents of Oregon who had signed up for a lottery that provides health insurance to people who lack it.

“They said they’re going to draw names, and if I’m on that list, then I’ll get health care,” said Mr. Tsosies, 58, a handyman here in booming Deschutes County. “So I’m just waiting right now.”

Despite the great hopes of people like Mr. Tsosies, only a few thousand of Oregon’s 600,000 uninsured residents are likely to benefit from the lottery anytime soon. The program has only enough money to pay for about 24,000 people, and at least 17,000 slots are already filled.

Health Plans Put Onus on Insured
By REED ABELSON

Let the patient beware. Going outside your insurer’s network of preferred doctors or hospitals could be even more hazardous to your financial health than you suspected.

The broad investigation that New York’s attorney general announced last week, questioning the “reasonable and customary” calculations on which insurers base reimbursements for out-of-network medical services, raised the lid on a particularly confusing part of the nation’s health care system.

For consumers, the issues go beyond whether insurers are underpaying for 15-minute visits to out-of-network doctors. The uncertainties can extend to the vast array of tests, services and even hospitalizations they may encounter on their medical journey — and the puzzle of determining which ones will be considered in network, out of network or paid for at all.

The study’s authors concluded that “individuals without private insurance are not receiving optimum care in terms of cancer screening or timely diagnosis and follow-up with health care providers.” Advanced-stage diagnosis, they wrote, “leads to increased morbidity, decreased quality of life and survival and, often, increased costs.”

Study Finds Cancer Diagnosis Linked to Insurance
By KEVIN SACK

ATLANTA — A nationwide study has found that the uninsured and those covered by Medicaid are more likely than those with private insurance to receive a diagnosis of cancer in late stages, often diminishing their chances of survival.

No consumer can reasonably trust numbers generated by a company whose loyalties and financial interests lie with the health insurers.

A Rip-Off by Health Insurers?

Have health insurers been systematically cheating patients and doctors of fair reimbursement for medical services? That is the disturbing possibility raised by an investigation of the industry’s arcane procedures for calculating “reasonable and customary” rates.

The investigation, by the New York State attorney general, Andrew Cuomo, and his staff, suggests that these procedures — used by major insurance companies to determine what they will pay when patients visit a doctor who is not in the company’s network — may be rigged to shortchange the beneficiaries.